Healthcare Provider Details

I. General information

NPI: 1770889842
Provider Name (Legal Business Name): GENLAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 WASHINGTON LN
JENKINTOWN PA
19046-3213
US

IV. Provider business mailing address

604 WASHINGTON LN
JENKINTOWN PA
19046-3213
US

V. Phone/Fax

Practice location:
  • Phone: 609-613-2226
  • Fax: 609-482-3702
Mailing address:
  • Phone: 609-613-2226
  • Fax: 609-482-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: THOMAS BELL
Title or Position: PRESIDENT
Credential:
Phone: 609-613-2226