Provider Demographics
NPI:1528636594
Name:UBERSTICKS MEDICAL LLC
Entity type:Organization
Organization Name:UBERSTICKS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEYANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA PLACENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-405-8595
Mailing Address - Street 1:4 MONROE ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-8108
Mailing Address - Country:US
Mailing Address - Phone:973-405-8595
Mailing Address - Fax:973-272-3647
Practice Address - Street 1:17 MONROE STREET
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8108
Practice Address - Country:US
Practice Address - Phone:973-405-8595
Practice Address - Fax:973-272-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service