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General NPI Number Information
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NPI Number | 1619194495
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Entity Type | Organization
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Legal Business Name | PATHOLOGY & LABORATORY SERVICES, LLC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11 RESEARCH DR SUITE 4
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2348
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Country | US
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Telephone | 203-389-4350
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Fax |
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Provider Business Mailing Address
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Address Line | 11 RESEARCH DR SUITE 4
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2348
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Country | US
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Telephone | 203-389-4350
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MRS. ELAINE CRISCUOLO
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Credential |
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Telephone | 203-389-4350
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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 | CL-0560
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License Number State | CT
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