1013099605 NPI number — BOSTWICK 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 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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