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General NPI Number Information
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NPI Number | 1013469733
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Entity Type | Organization
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Legal Business Name | PARK DIAGNOSTICS LABORATORIES LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 12008 131ST ST
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-2922
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Country | US
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Telephone | 646-300-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 12008 131ST STREET
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City | SO OZONE PARK
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State | NY
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Zip | 11420
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Country | US
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Telephone | 646-300-2399
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. BENJAMIN ABRAHAM
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Credential | MD
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Telephone | 646-300-2399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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