1770984239 NPI number — ABIRA MEDICAL LABORATORIES

Table of content: (NPI 1770984239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770984239 NPI number — ABIRA MEDICAL LABORATORIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABIRA MEDICAL LABORATORIES
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:
6
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:
1770984239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 TOWN CENTER DR
Provider Second Line Business Mailing Address:
SUITE H-50
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-212-2000
Provider Business Mailing Address Fax Number:
267-212-2005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 TOWN CENTER DR
Provider Second Line Business Practice Location Address:
SUITE H-50
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-212-2000
Provider Business Practice Location Address Fax Number:
267-212-2005
Provider Enumeration Date:
09/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VERNON
Authorized Official First Name:
ELLIOTT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
267-212-2000

Provider Taxonomy Codes

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

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

  • Identifier: 020782600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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