Provider Demographics
NPI:1194971085
Name:LINCOLN DIAGNOSTICS LLC
Entity type:Organization
Organization Name:LINCOLN DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-347-6564
Mailing Address - Street 1:1023 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5025
Mailing Address - Country:US
Mailing Address - Phone:908-583-5421
Mailing Address - Fax:908-487-6492
Practice Address - Street 1:1023 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5025
Practice Address - Country:US
Practice Address - Phone:908-583-5421
Practice Address - Fax:908-487-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8315291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000325Medicare PIN