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General NPI Number Information
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NPI Number | 1255771820
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Entity Type | Organization
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Legal Business Name | AVENIR SCIENTIFIC LABORATORY
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 3112 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-4126
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Country | US
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Telephone | 954-909-5188
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Fax | 954-909-5189
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Provider Business Mailing Address
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Address Line | 3112 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-4126
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Country | US
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Telephone | 954-909-5188
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Fax | 954-909-5189
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Authorized Official
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Title or Position | CEO
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Name | DAVID L MUSKAT
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Credential |
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Telephone | 954-909-5188
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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 |
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License Number State | FL
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