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General NPI Number Information
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NPI Number | 1104578335
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Entity Type | Organization
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Legal Business Name | NZJNG LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 5821 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60639-2812
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Country | US
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Telephone | 773-885-6397
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Fax |
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Provider Business Mailing Address
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Address Line | 4940 S HONORE ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60609-4494
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Country | US
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Telephone | 773-885-6397
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MELAINE GLORIA LEBRON
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Credential | CLIA CERIFICATION
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Telephone | 773-885-6397
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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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