=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073944120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERILABS LIMITED LIABILITY COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2013
-----------------------------------------------------
Last Update Date | 04/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 CORLIES AVE 1ST FLOOOR
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-898-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 CORLIES AVE 1ST FLOOOR
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-898-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMIN F AL-LATY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-898-7300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 25MS00003800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------