1427627090 NPI number — KEAN CLINICAL DIAGNOSTICS LAB

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 1427627090 NPI number — KEAN CLINICAL DIAGNOSTICS LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEAN CLINICAL DIAGNOSTICS LAB
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:
1427627090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MORRIS AVE STEM BLDG. 5-13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07083-7133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-737-7207
Provider Business Mailing Address Fax Number:
908-737-7205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 MORRIS AVE
Provider Second Line Business Practice Location Address:
STEM BLDG. 5-13
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07083-7137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-737-7207
Provider Business Practice Location Address Fax Number:
908-737-7205
Provider Enumeration Date:
06/18/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOSTIAN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
DEAN
Authorized Official Telephone Number:
908-216-6609

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)