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General NPI Number Information
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NPI Number | 1245309111
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Entity Type | Organization
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Legal Business Name | BAYSIDE LABORATORIES
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | T. BAYSIDE LABORA LAB 45 57 BELL BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3354
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Country | US
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Telephone | 718-229-8800
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Fax | 718-224-7225
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Provider Business Mailing Address
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Address Line | 4557 BELL BLVD
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City | FLUSHING
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State | NY
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Zip | 11361-3354
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Country | US
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Telephone | 718-229-8800
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Fax | 718-224-7225
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARGARITA PESTUN
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Credential |
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Telephone | 718-229-8800
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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 | 33D0149650
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License Number State | NY
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