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General NPI Number Information
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NPI Number | 1124354253
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Entity Type | Organization
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Legal Business Name | RADIANT LABORATORY ASSOCIATES LLC
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Dates
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Enumeration Date | 10/24/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 59 OAK ST B
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City | HACKENSACK
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State | NJ
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Zip | 07601-4927
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Country | US
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Telephone | 201-336-0042
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Fax | 201-336-0222
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Provider Business Mailing Address
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Address Line | 59 OAK ST B
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City | HACKENSACK
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State | NJ
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Zip | 07601-4927
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Country | US
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Telephone | 201-336-0042
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Fax | 201-336-0222
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Authorized Official
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Title or Position | TECHNICAL SUPERVISOR/OWNER
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Name | MR. SAIYYED HASAN
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Credential |
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Telephone | 201-336-0042
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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 | NJ
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