1073863270 NPI number — BIOREFERENCE HEALTH, LLC

Table of content: (NPI 1073863270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073863270 NPI number — BIOREFERENCE HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOREFERENCE HEALTH, LLC
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:
BIO-REFERENCE LABORATORIES, INC.
Provider Other Organization Name Type Code:
4
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:
1073863270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
481 EDWARD H ROSS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMWOOD PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07407-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-229-5227
Provider Business Mailing Address Fax Number:
201-791-1941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 MINEOLA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-2594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-229-5227
Provider Business Practice Location Address Fax Number:
201-791-1941
Provider Enumeration Date:
09/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMID
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
201-791-2600

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  33D0982993 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33D0982993 . This is a "CLIA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7955 . This is a "STATE LICENES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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