Provider Demographics
NPI:1366909921
Name:MINEOLA CLINICAL LABORATORY, LLC
Entity type:Organization
Organization Name:MINEOLA CLINICAL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINE WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-2600
Mailing Address - Street 1:481 EDWARD H ROSS DR
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3118
Mailing Address - Country:US
Mailing Address - Phone:201-791-2600
Mailing Address - Fax:
Practice Address - Street 1:174 MINEOLA BLVD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2513
Practice Address - Country:US
Practice Address - Phone:305-575-4181
Practice Address - Fax:201-791-1941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPKO HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-01
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory