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General NPI Number Information
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NPI Number | 1205770112
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Entity Type | Organization
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Legal Business Name | MOBILE LAB SOLUTIONS, INC
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 656 SAG HARBOR TURNPIKE
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City | BRIDGEHAMPTON
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State | NY
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Zip | 11932
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Country | US
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Telephone | 631-276-8176
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1534
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City | BRIDGEHAMPTON
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State | NY
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Zip | 11932-1534
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Country | US
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Telephone | 631-276-8176
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Fax |
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Authorized Official
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Title or Position | PHLEBOTOMY TECHNICIAN
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Name | DOMINIQUE SHARICE CLARK
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Credential | CPT
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Telephone | 631-276-8176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246Q00000X
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Taxonomy Name | Pathology Specialist/Technologist
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License Number |
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License Number State |
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