Provider Demographics
NPI:1104578335
Name:NZJNG LLC
Entity type:Organization
Organization Name:NZJNG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELAINE
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:CLIA CERIFICATION
Authorized Official - Phone:773-885-6397
Mailing Address - Street 1:4940 S HONORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4494
Mailing Address - Country:US
Mailing Address - Phone:773-885-6397
Mailing Address - Fax:
Practice Address - Street 1:5821 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2812
Practice Address - Country:US
Practice Address - Phone:773-885-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory