Healthcare Provider Details

I. General information

NPI: 1093661936
Provider Name (Legal Business Name): STICK & GO MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 EDGEWOOD DR
CENTRAL VALLEY NY
10917-3205
US

IV. Provider business mailing address

58 EDGEWOOD DR
CENTRAL VALLEY NY
10917-3205
US

V. Phone/Fax

Practice location:
  • Phone: 917-318-3665
  • Fax:
Mailing address:
  • Phone: 917-318-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: EVELYN LORA
Title or Position: PHLEBOTOMY
Credential:
Phone: 917-318-3665