Healthcare Provider Details

I. General information

NPI: 1124117890
Provider Name (Legal Business Name): CLINICAL SCIENCE LABORATORY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 FRANCIS AVE
MANSFIELD MA
02048-1511
US

IV. Provider business mailing address

PO BOX 347
MANSFIELD MA
02048-0347
US

V. Phone/Fax

Practice location:
  • Phone: 508-339-6106
  • Fax: 508-339-3540
Mailing address:
  • Phone: 508-339-6106
  • Fax: 508-339-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number5488
License Number StateMA

VIII. Authorized Official

Name: DR. STANLEY G ELFBAUM
Title or Position: PRESIDENT
Credential: PH.D
Phone: 508-339-6106