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General NPI Number Information
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NPI Number | 1043869068
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Entity Type | Organization
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Legal Business Name | CHAMPLAIN TOXICOLOGY LAB, LLC
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 32 VETERANS LN STE 2
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City | PLATTSBURGH
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State | NY
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Zip | 12901-1217
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Country | US
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Telephone | 518-324-5261
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Fax | 518-324-3366
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Provider Business Mailing Address
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Address Line | 32 VETERANS LN STE 2
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City | PLATTSBURGH
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State | NY
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Zip | 12901-1223
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Country | US
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Telephone | 518-324-1698
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | MR. THIERRY P. BONNABESSE
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Credential | MD
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Telephone | 518-324-7246
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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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