Provider Demographics
NPI:1124117890
Name:CLINICAL SCIENCE LABORATORY INC.
Entity type:Organization
Organization Name:CLINICAL SCIENCE LABORATORY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELFBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-339-6106
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-0347
Mailing Address - Country:US
Mailing Address - Phone:508-339-6106
Mailing Address - Fax:508-339-3540
Practice Address - Street 1:51 FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1511
Practice Address - Country:US
Practice Address - Phone:508-339-6106
Practice Address - Fax:508-339-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5488291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0802298Medicaid
LAP#113890OtherCOLLEGE AMER PATHOLOGISTS
22D007402OtherCLIA
NH30004689OtherDEPT OF HEALTH NH
RI00180OtherDEPT OF HEALTH RI
PA024916OtherDEPT OF HEALTH PA
NYPFI8096OtherDEPT OF HEALTH NY
RI00180OtherDEPT OF HEALTH RI