1013099605 NPI number — BOSTWICK LABORATORIES, INC,

Table of content: (NPI 1013099605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013099605 NPI number — BOSTWICK LABORATORIES, INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTWICK LABORATORIES, INC,
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013099605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 403751
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-3751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-967-9225
Provider Business Mailing Address Fax Number:
804-239-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CHARLES LINDBERGH BLVD
Provider Second Line Business Practice Location Address:
BOSTWICK LABORATORIES, INC.
Provider Business Practice Location Address City Name:
UNIONDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11553-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-967-9225
Provider Business Practice Location Address Fax Number:
804-239-1954
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEFANELLI
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
516-512-5200

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1009021320003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79430881 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013099605 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810015664 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 443513 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127456200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013099605 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138056 . This is a "ANTHEM BCBS OF VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1372021 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200931890A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000265165 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200024720D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7147846 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100003869 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013099605 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10111299 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001365 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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