Healthcare Provider Details

I. General information

NPI: 1548152093
Provider Name (Legal Business Name): KRJS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 COMMUNICATION AVE STE 250
BOCA RATON FL
33431-3308
US

IV. Provider business mailing address

4950 COMMUNICATION AVE STE 250
BOCA RATON FL
33431-3308
US

V. Phone/Fax

Practice location:
  • Phone: 561-319-7907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN MODIST
Title or Position: MANAGING PARTNER
Credential:
Phone: 561-319-7907