Provider Demographics
NPI:1427627090
Name:KEAN CLINICAL DIAGNOSTICS LAB
Entity type:Organization
Organization Name:KEAN CLINICAL DIAGNOSTICS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BOSTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-216-6609
Mailing Address - Street 1:1000 MORRIS AVE STEM BLDG. 5-13
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7133
Mailing Address - Country:US
Mailing Address - Phone:908-737-7207
Mailing Address - Fax:908-737-7205
Practice Address - Street 1:1075 MORRIS AVE
Practice Address - Street 2:STEM BLDG. 5-13
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7137
Practice Address - Country:US
Practice Address - Phone:908-737-7207
Practice Address - Fax:908-737-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory