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General NPI Number Information
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NPI Number | 1891268587
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Entity Type | Organization
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Legal Business Name | INLAB DIAGNOSTIC, LLC
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Dates
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Enumeration Date | 01/06/2019
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Last Update Date | 01/06/2019
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Provider Practice Location Address
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Address Line | 466 MAIN ST STE 207
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-6431
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Country | US
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Telephone | 914-740-5553
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Fax |
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Provider Business Mailing Address
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Address Line | 466 MAIN ST STE 207
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-6431
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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 | PRESIDENT & CEO
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Name | MR. ISAIAH LEACH
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Credential |
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Telephone | 917-239-1214
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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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