MEDICARE: L&M LAB CORP

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	33D2077603	NY
2	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33D2077603	OTHER		LICENSE

General Provider Information

NPI Number	:	1932589041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L&M LAB CORP

Provider Business Mailing Address
First Line	:	220 DAVIDSON AVE STE 104
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-4144
Country	:	US
Telephone Number	:	718-759-6568
Fax Number	:	718-759-6569

Provider Business Practice Location Address
First Line	:	2960 OCEAN AVE STE 5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3286
Country	:	US
Telephone Number	:	718-759-6568
Fax Number	:	718-759-6569

Authorized Official
Title or Position	:	OWNER
Name	:	LOLA NISAN
Credential	:
Telephone Number	:	718-759-6568

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	03/22/2022

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Directions to “L&M LAB CORP ” Practice Location

Language	Start Address	Practice Location

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