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General NPI Number Information
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NPI Number | 1679584361
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Entity Type | Organization
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Legal Business Name | PARK MADISON PROFESSIONAL LABORATORIES, INC.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 97 E 4TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-9002
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Country | US
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Telephone | 212-628-7900
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Fax | 212-628-7950
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Provider Business Mailing Address
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Address Line | 97 E 4TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-9002
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Country | US
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Telephone | 212-628-7900
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Fax | 212-628-7950
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. TIM DRESSLER
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Credential |
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Telephone | 212-628-7900
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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 | 33D0130762
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License Number State | NY
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