MEDICARE: ZTAK LAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	10D2112438	FL

General Provider Information

NPI Number	:	1841749579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZTAK LAB LLC

Provider Business Mailing Address
First Line	:	3395 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-6902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3395 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-6902
Country	:	US
Telephone Number	:	561-410-5566
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABE KATZ
Credential	:
Telephone Number	:	347-413-1037

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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Directions to “ZTAK LAB LLC ” Practice Location

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