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General NPI Number Information
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NPI Number | 1841749579
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Entity Type | Organization
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Legal Business Name | ZTAK LAB LLC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 3395 LAKE WORTH RD
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City | PALM SPRINGS
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State | FL
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Zip | 33461-6902
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Country | US
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Telephone | 561-410-5566
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Fax |
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Provider Business Mailing Address
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Address Line | 3395 LAKE WORTH RD
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City | PALM SPRINGS
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State | FL
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Zip | 33461-6902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABE KATZ
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Credential |
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Telephone | 347-413-1037
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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 | 10D2112438
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License Number State | FL
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