Healthcare Provider Details

I. General information

NPI: 1871526384
Provider Name (Legal Business Name): BOSTWICK LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 LAKE ELLENOR DR SUITE 2
ORLANDO FL
32809-4631
US

IV. Provider business mailing address

PO BOX 403751
ATLANTA GA
30384-3751
US

V. Phone/Fax

Practice location:
  • Phone: 407-888-9937
  • Fax: 407-856-0333
Mailing address:
  • Phone: 804-967-9225
  • Fax: 804-239-1954

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: MR. MARTIN J STEFANELLI
Title or Position: CEO
Credential:
Phone: 516-512-5200