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General NPI Number Information
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NPI Number | 1326749888
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Entity Type | Individual
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Provider Name | ANI QU LAB DIRECTOR
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Gender | Male
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 694 EWING STREET, PRINCETON, NJ, 08540. 12 ROSZEL ROAD, B102
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City | PRINCETON
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State | NJ
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Zip | 08540-6254
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Country | US
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Telephone | 609-878-2889
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Fax | 609-913-2889
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Provider Business Mailing Address
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Address Line | 694 EWING ST
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City | PRINCETON
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State | NJ
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Zip | 08540-2739
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Country | US
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Telephone | 609-878-2889
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Fax | 609-913-2889
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | 25MS00021900
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License Number State | NJ
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