Provider Demographics
NPI:1366121139
Name:ABIC DIAGNOSTIC LAB AND FINGERPRINTING LLC
Entity type:Organization
Organization Name:ABIC DIAGNOSTIC LAB AND FINGERPRINTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-391-3385
Mailing Address - Street 1:4213 WYNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6171
Mailing Address - Country:US
Mailing Address - Phone:973-391-3385
Mailing Address - Fax:866-413-1056
Practice Address - Street 1:11238 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1900
Practice Address - Country:US
Practice Address - Phone:973-391-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service