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General NPI Number Information
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NPI Number | 1780041475
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Entity Type | Organization
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Legal Business Name | CT LABS LLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 417 HIGHLAND AVE STE 2
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City | WATERBURY
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State | CT
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Zip | 06708-3454
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Country | US
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Telephone | 203-757-9336
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Fax | 888-532-1877
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Provider Business Mailing Address
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Address Line | 417 HIGHLAND AVE STE 2
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City | WATERBURY
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State | CT
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Zip | 06708-3454
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Country | US
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Telephone | 203-757-9336
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Fax | 888-532-1877
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCOS DE ESCOBAR
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Credential | NMD
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Telephone | 203-757-9336
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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 | MD971566
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License Number State | CT
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