Provider Demographics
NPI:1366543795
Name:NORTHWELL HEALTH LABORATORIES
Entity type:Organization
Organization Name:NORTHWELL HEALTH LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-494-8760
Mailing Address - Street 1:2200 NORTHERN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1220
Mailing Address - Country:US
Mailing Address - Phone:516-407-6665
Mailing Address - Fax:516-407-6744
Practice Address - Street 1:450 LAKEVILLE RD STE M50
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1117
Practice Address - Country:US
Practice Address - Phone:516-719-1000
Practice Address - Fax:516-407-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960907Medicaid
NY33D0653792OtherCLIA
NY33D2149088OtherLITTLE NECK PRKWY CLIA NUMBER
NYNO0L880810Medicare ID - Type UnspecifiedPROVIDER ID