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General NPI Number Information
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NPI Number | 1972538593
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Entity Type | Organization
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Legal Business Name | WANTAGH DIAGNOSTIC LAB INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1228 WANTAGH AVENUE SUITE LLI
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City | WANTAGH
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State | NY
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Zip | 11793
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Country | US
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Telephone | 516-221-0002
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Fax | 516-221-3241
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Provider Business Mailing Address
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Address Line | 1228 WANTAGH AVENUE
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City | WANTAGH
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State | NY
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Zip | 11793
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Country | US
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Telephone | 516-221-0002
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Fax | 516-221-3241
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MRS. MAUREEN DONOHUE
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Credential |
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Telephone | 516-221-0002
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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 | NY
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