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General NPI Number Information
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NPI Number | 1598827636
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Entity Type | Organization
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Legal Business Name | L2 DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 CEDAR ST. TAC ROOM S-525
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City | NEW HAVEN
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State | CT
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Zip | 06520-8031
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Country | US
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Telephone | 203-737-1952
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 208031 300 CEDAR ST. TAC ROOM S-525
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City | NEW HAVEN
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State | CT
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Zip | 06520-8031
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Country | US
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Telephone | 203-737-1952
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE PROFESSOR OF MEDICINE
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Name | MARK J MAMULA
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Credential | PH.D.
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Telephone | 203-785-2840
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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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