| NPI | 1235208992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLOWMENIA ISDORA COSTA President 631-462-4400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: NY PFI4386) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: NY CLIA33D0674863) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2015-08-26 |