| NPI | 1932589041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOLA NISAN Owner 718-759-6568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: NY 33D2077603) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2022-03-22 |