Provider Demographics
NPI:1588375828
Name:1 LAB DIAGNOSTICS NJ LLC
Entity type:Organization
Organization Name:1 LAB DIAGNOSTICS NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-657-9011
Mailing Address - Street 1:1044 N US HIGHWAY 1 STE 201
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4308
Mailing Address - Country:US
Mailing Address - Phone:724-570-5852
Mailing Address - Fax:
Practice Address - Street 1:107 GAITHER DR STE B
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1730
Practice Address - Country:US
Practice Address - Phone:724-570-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450896170OtherNJ DEPARTMENT OF THE TREASURY