1821091067 NPI number — ABACUS BUSINESS CORPORATION GROUP 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 1821091067 NPI number — ABACUS BUSINESS CORPORATION GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABACUS BUSINESS CORPORATION GROUP 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:
AMERICAN BIO-CLINICAL LABORATORIES
Provider Other Organization Name Type Code:
3
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:
1821091067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90031-3321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-222-6688
Provider Business Mailing Address Fax Number:
323-222-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90031-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-222-6688
Provider Business Practice Location Address Fax Number:
323-222-3388
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SOMALI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-222-6688

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  104749-60 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAB04154F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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