Healthcare Provider Details

I. General information

NPI: 1124022199
Provider Name (Legal Business Name): DOWNSTATE CLINICAL LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 HILLSIDE AVE
NEW HYDE PARK NY
11040-2714
US

IV. Provider business mailing address

2209 HILLSIDE AVE
NEW HYDE PARK NY
11040-2714
US

V. Phone/Fax

Practice location:
  • Phone: 516-693-0401
  • Fax: 516-693-0404
Mailing address:
  • Phone: 516-693-0401
  • Fax: 516-693-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number4345 33D0711978
License Number StateNY

VIII. Authorized Official

Name: MR. LEWIS FRANCIS SCALIONE
Title or Position: PRESIDENT
Credential:
Phone: 516-693-0401