=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891456695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAST LAB CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2022
-----------------------------------------------------
Last Update Date | 06/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 WAVERLY AVE STE 100
-----------------------------------------------------
City | HOLTSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11742-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-975-7040
-----------------------------------------------------
Fax | 631-204-6300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 WAVERLY AVE STE 100
-----------------------------------------------------
City | HOLTSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11742-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-975-7040
-----------------------------------------------------
Fax | 631-204-6300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SYED MUNTIQA SHAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-997-8787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------