Provider Demographics
NPI:1205090073
Name:SYNERGY LABORATORIES, INC.
Entity type:Organization
Organization Name:SYNERGY LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIGMAN-FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-220-9159
Mailing Address - Street 1:1000 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE #440-249
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6170
Mailing Address - Country:US
Mailing Address - Phone:702-220-9159
Mailing Address - Fax:702-263-9388
Practice Address - Street 1:4161 S EASTERN AVE
Practice Address - Street 2:SUITE A-6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5484
Practice Address - Country:US
Practice Address - Phone:702-220-9159
Practice Address - Fax:702-248-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4648LIC-1291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory