Healthcare Provider Details

I. General information

NPI: 1053906636
Provider Name (Legal Business Name): NOVA DIAGNOSTICS LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 S HIGHLAND AVE STE 275
LOMBARD IL
60148-5371
US

IV. Provider business mailing address

2340 S HIGHLAND AVE STE 275
LOMBARD IL
60148-5371
US

V. Phone/Fax

Practice location:
  • Phone: 331-210-5555
  • Fax:
Mailing address:
  • Phone: 872-330-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ABDUL RAHEEM
Title or Position: OWNER
Credential:
Phone: 872-330-2821