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General NPI Number Information
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NPI Number | 1568950194
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY TOXICOLOGY, LLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 1000 HADDONFIELD BERLIN RD STE 120
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City | VOORHEES
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State | NJ
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Zip | 08043-3520
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Country | US
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Telephone | 856-454-7690
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 WILLOW CREEK RD. A 101-462
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City | PRESCOTT
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State | AZ
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Zip | 86301
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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 | LAB DIRECTOR
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Name | MR. ALAN SHIENBAUM
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Credential |
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Telephone | 267-265-6734
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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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