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General NPI Number Information
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NPI Number | 1043813108
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Entity Type | Organization
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Legal Business Name | MED BAR LLC
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 106 FIELDCREST ROAD
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City | CHARLESTON
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State | WV
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Zip | 25314
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Country | US
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Telephone | 646-933-5677
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Fax |
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Provider Business Mailing Address
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Address Line | 90 CHURCH ST UNIT 7080
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City | NEW YORK
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State | NY
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Zip | 10008-9770
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | FAHAD BAFAKIH
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Credential |
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Telephone | 646-933-5677
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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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