MEDICARE: EMPIRE CITY LABORATORIES, INC

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	:	1053584482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE CITY LABORATORIES, INC

Provider Business Mailing Address
First Line	:	229 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1708
Country	:	US
Telephone Number	:	718-788-3840
Fax Number	:	347-227-1423

Provider Business Practice Location Address
First Line	:	229 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1708
Country	:	US
Telephone Number	:	718-788-3840
Fax Number	:	347-227-1423

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MICHAEL NISANOV
Credential	:
Telephone Number	:	718-788-3840

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	06/10/2019

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