Healthcare Provider Details

I. General information

NPI: 1598402711
Provider Name (Legal Business Name): NYC LABORATORIES PR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E 40TH ST
NEW YORK NY
10016-0401
US

IV. Provider business mailing address

560 HUDSON ST FL 3
HACKENSACK NJ
07601-6655
US

V. Phone/Fax

Practice location:
  • Phone: 551-298-3432
  • Fax: 212-888-6024
Mailing address:
  • Phone: 201-641-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: ANDRES ROSA
Title or Position: DIRECTOR
Credential:
Phone: 201-641-2125