Healthcare Provider Details

I. General information

NPI: 1124354253
Provider Name (Legal Business Name): RADIANT LABORATORY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 OAK ST B
HACKENSACK NJ
07601-4927
US

IV. Provider business mailing address

59 OAK ST B
HACKENSACK NJ
07601-4927
US

V. Phone/Fax

Practice location:
  • Phone: 201-336-0042
  • Fax: 201-336-0222
Mailing address:
  • Phone: 201-336-0042
  • Fax: 201-336-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SAIYYED HASAN
Title or Position: TECHNICAL SUPERVISOR/OWNER
Credential:
Phone: 201-336-0042