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General NPI Number Information
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NPI Number | 1508451527
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Entity Type | Organization
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Legal Business Name | MASONIC MEDICAL RESEARCH LABORATORY
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 2150 BLEECKER ST
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City | UTICA
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State | NY
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Zip | 13501-1738
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Country | US
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Telephone | 315-735-2217
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 BLEECKER ST
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City | UTICA
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State | NY
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Zip | 13501-1738
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | SUSAN BARTKOWIAK
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Credential |
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Telephone | 315-624-7487
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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 |
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