MEDICARE: GERIATREX LAB SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1053121244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATREX LAB SERVICES LLC

Provider Business Mailing Address
First Line	:	36 STRATFORD C
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-6737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 STRATFORD C
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-6737
Country	:	US
Telephone Number	:	917-559-0351
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MENACHEM GREENWALD
Credential	:
Telephone Number	:	917-559-0351

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	01/09/2025

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