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General NPI Number Information
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NPI Number | 1538416243
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Entity Type | Organization
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Legal Business Name | LIFETEST LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 2455 MCDONALD AVE UNIT 2
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City | BROOKLYN
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State | NY
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Zip | 11223-5232
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Country | US
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Telephone | 347-623-3916
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Fax |
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Provider Business Mailing Address
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Address Line | 2455 MCDONALD AVE UNIT 2
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City | BROOKLYN
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State | NY
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Zip | 11223-5232
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Country | US
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Telephone | 347-623-3916
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELENA ABRAMYAN
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Credential |
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Telephone | 347-623-3916
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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 | 33D2047144
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License Number State | NY
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