Healthcare Provider Details

I. General information

NPI: 1205770112
Provider Name (Legal Business Name): MOBILE LAB SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 SAG HARBOR TURNPIKE
BRIDGEHAMPTON NY
11932
US

IV. Provider business mailing address

P.O. BOX 1534
BRIDGEHAMPTON NY
11932-1534
US

V. Phone/Fax

Practice location:
  • Phone: 631-276-8176
  • Fax:
Mailing address:
  • Phone: 631-276-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE SHARICE CLARK
Title or Position: PHLEBOTOMY TECHNICIAN
Credential: CPT
Phone: 631-276-8176