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General NPI Number Information
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NPI Number | 1740237304
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Entity Type | Organization
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Legal Business Name | WILLOW STREET MEDICAL LAB LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 280 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1353
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Country | US
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Telephone | 781-593-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 280 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1353
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Country | US
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Telephone | 781-268-2400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | GAIL B MARCUS
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Credential |
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Telephone | 781-268-2400
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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 | 2346
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License Number State | MA
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