1366487233 NPI number — LENETIX MEDICAL SCREENING LABORATORY

Table of content: (NPI 1366487233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366487233 NPI number — LENETIX MEDICAL SCREENING LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LENETIX MEDICAL SCREENING LABORATORY
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:
1366487233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
174 MINEOLA BLVD
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-2513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-248-0036
Provider Business Mailing Address Fax Number:
516-248-4436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 MINEOLA BLVD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-248-0036
Provider Business Practice Location Address Fax Number:
516-248-4436
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLNER
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
516-248-0036

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 02698231 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001267 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013885690001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4490741 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2579302 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3133379 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com