1700039435 NPI number — GLADZIM MEDICAL LABORATORIES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700039435 NPI number — GLADZIM MEDICAL LABORATORIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLADZIM MEDICAL 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:
1700039435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 FRANKLIN ST
Provider Second Line Business Mailing Address:
UNIT #3
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-4978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-619-2622
Provider Business Mailing Address Fax Number:
973-677-1181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 S MUNN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07018-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-619-2622
Provider Business Practice Location Address Fax Number:
973-677-1181
Provider Enumeration Date:
10/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
IBEZIM
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
NGOZI
Authorized Official Title or Position:
PRESIDENT & DIRECTOR
Authorized Official Telephone Number:
973-619-2622

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLIA ID 33D1034578 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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