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General NPI Number Information
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NPI Number | 1134107972
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Entity Type | Organization
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Legal Business Name | GJL MEDICAL LABORATORIES, INC.
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 271 JERICHO TPKE
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City | FLORAL PARK
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State | NY
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Zip | 11001-2146
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Country | US
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Telephone | 516-326-0700
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Fax | 516-616-4581
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Provider Business Mailing Address
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Address Line | 271 JERICHO TPKE PO BOX 540
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City | FLORAL PARK
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State | NY
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Zip | 11001-2146
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Country | US
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Telephone | 516-326-0700
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Fax | 516-616-4581
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOSEPHINE F. BANNERJEE
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Credential | M.D.
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Telephone | 516-326-0700
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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 | 2317
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License Number State | NY
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