Provider Demographics
NPI:1215658018
Name:MARTINGALE LABS, INC.
Entity type:Organization
Organization Name:MARTINGALE LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATWARDHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-600-0077
Mailing Address - Street 1:202 ZAPATA LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:494 4TH AVE # 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3914
Practice Address - Country:US
Practice Address - Phone:919-600-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center