Healthcare Provider Details

I. General information

NPI: 1861404121
Provider Name (Legal Business Name): EAST SIDE CLINICAL LABORATORY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RISHO AVE
EAST PROVIDENCE RI
02914-1227
US

IV. Provider business mailing address

10 RISHO AVE
EAST PROVIDENCE RI
02914-1227
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-8400
  • Fax: 401-455-8444
Mailing address:
  • Phone: 401-455-8400
  • Fax: 401-455-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberLCI00449
License Number StateRI

VIII. Authorized Official

Name: ALAN M. GREENBERG
Title or Position: PRESIDENT
Credential:
Phone: 516-396-5800