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General NPI Number Information
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NPI Number | 1235208992
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Entity Type | Organization
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Legal Business Name | ACE CLINICAL LABORATORY, INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 283 COMMACK ROAD SUITE 204
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City | COMMACK
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State | NY
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Zip | 11725
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Country | US
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Telephone | 631-462-4400
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Fax | 631-462-3431
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Provider Business Mailing Address
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Address Line | 283 COMMACK ROAD SUITE 315
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City | COMMACK
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State | NY
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Zip | 11725
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Country | US
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Telephone | 631-462-4400
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Fax | 631-462-3431
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. WILLOWMENIA ISDORA COSTA
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Credential |
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Telephone | 631-462-4400
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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 | CLIA33D0674863
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | PFI4386
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License Number State | NY
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