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General NPI Number Information
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NPI Number | 1235665175
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Entity Type | Organization
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Legal Business Name | SUNRISE CLINICAL LAB, LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 22 BALL ST SUITE # 2
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City | IRVINGTON
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State | NJ
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Zip | 07111-3521
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Country | US
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Telephone | 973-757-2184
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Fax | 973-757-2022
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Provider Business Mailing Address
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Address Line | 22 BALL ST SUITE # 2
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City | IRVINGTON
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State | NJ
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Zip | 07111-3521
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Country | US
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Telephone | 973-757-2184
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Fax | 973-757-2022
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Authorized Official
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Title or Position | CEO
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Name | MR. TUSEEAF T RATHORE
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Credential |
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Telephone | 201-668-5016
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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 | 00043167
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License Number State | NJ
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