Provider Demographics
NPI:1285378356
Name:OPTIMAL LAB INC
Entity type:Organization
Organization Name:OPTIMAL LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-204-5564
Mailing Address - Street 1:714 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-3402
Mailing Address - Country:US
Mailing Address - Phone:973-341-3844
Mailing Address - Fax:973-341-4558
Practice Address - Street 1:714 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-3402
Practice Address - Country:US
Practice Address - Phone:973-341-3844
Practice Address - Fax:973-341-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory