MEDICARE: ADVANCED COMPREHENSIVE LABORATORY

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	0011490	NJ

General Provider Information

NPI Number	:	1669990701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED COMPREHENSIVE LABORATORY

Provider Business Mailing Address
First Line	:	67-71 EAST WILLOW STREET
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-9999
Country	:	US
Telephone Number	:	877-355-3580
Fax Number	:	866-899-3995

Provider Business Practice Location Address
First Line	:	67-71 EAST WILLOW STREET
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-9999
Country	:	US
Telephone Number	:	877-355-3580
Fax Number	:	866-899-3995

Authorized Official
Title or Position	:	CEO
Name	:	VICTORIA FRENKEL
Credential	:
Telephone Number	:	877-355-3580

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	04/30/2018

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