Healthcare Provider Details

I. General information

NPI: 1629737200
Provider Name (Legal Business Name): DNTP LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CEDAR LN SIDE ENTRANCE
TEANECK NJ
07666-1706
US

IV. Provider business mailing address

780 CEDAR LN SIDE ENTRANCE
TEANECK NJ
07666-1706
US

V. Phone/Fax

Practice location:
  • Phone: 347-469-9491
  • Fax:
Mailing address:
  • Phone: 347-469-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MD RASEL AHSAN
Title or Position: PRESIDENT
Credential:
Phone: 347-469-9491