Provider Demographics
NPI:1124024922
Name:SPECTRA EAST, INC.
Entity type:Organization
Organization Name:SPECTRA EAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-2306
Mailing Address - Street 1:8 KING RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEIGH
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2502
Mailing Address - Country:US
Mailing Address - Phone:201-767-7070
Mailing Address - Fax:201-799-4551
Practice Address - Street 1:8 KING RD
Practice Address - Street 2:
Practice Address - City:ROCKLEIGH
Practice Address - State:NJ
Practice Address - Zip Code:07647-2502
Practice Address - Country:US
Practice Address - Phone:201-767-7070
Practice Address - Fax:201-799-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0001348291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017643320002Medicaid
TX071470101Medicaid
KY37000007Medicaid
OH2138672Medicaid
GA690008572OtherRAILROAD MEDICARE
AL009912670Medicaid
NY02010011Medicaid
VA004996909Medicaid
FL030641000Medicaid
MA0805955Medicaid
WV5580063000Medicaid
CT003106160Medicaid
NH30800684Medicaid
GA000843488AMedicaid
NJ8086605Medicaid
NC7001179Medicaid
NC7001179Medicaid
NC7001179Medicaid