Provider Demographics
NPI:1306925771
Name:LINDENHURST MEDICAL LABORATORY INC
Entity type:Organization
Organization Name:LINDENHURST MEDICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:631-226-2626
Mailing Address - Street 1:103 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3710
Mailing Address - Country:US
Mailing Address - Phone:631-226-2626
Mailing Address - Fax:631-226-2720
Practice Address - Street 1:103 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3710
Practice Address - Country:US
Practice Address - Phone:631-226-2626
Practice Address - Fax:631-226-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPFI2316291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPFI2316OtherNYS DOH
NYL81161Medicare ID - Type Unspecified
X17698Medicare UPIN