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General NPI Number Information
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NPI Number | 1629872478
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Entity Type | Organization
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Legal Business Name | AMTAJ ENTERPRISE LLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 15 MIRIN AVE
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City | ROOSEVELT
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State | NY
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Zip | 11575-1603
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Country | US
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Telephone | 347-741-3161
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Fax | 347-741-3161
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Provider Business Mailing Address
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Address Line | 15 MIRIN AVE
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City | ROOSEVELT
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State | NY
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Zip | 11575-1603
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Country | US
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Telephone | 347-741-3161
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Fax | 347-741-3161
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Authorized Official
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Title or Position | SPECIMEN COLLECTOR
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Name | SASHAI LAING
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Credential |
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Telephone | 347-741-3161
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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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