Provider Demographics
NPI:1588757033
Name:ENIGMA MANAGEMENT CORP DBA ALLIANCE LABORATORY
Entity type:Organization
Organization Name:ENIGMA MANAGEMENT CORP DBA ALLIANCE LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-851-5773
Mailing Address - Street 1:3611 14TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3787
Mailing Address - Country:US
Mailing Address - Phone:718-851-5773
Mailing Address - Fax:718-851-3919
Practice Address - Street 1:3611 14TH AVE
Practice Address - Street 2:STE 220
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3750
Practice Address - Country:US
Practice Address - Phone:718-851-5773
Practice Address - Fax:718-851-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0985206291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02683489Medicaid
NY=========OtherMAGNACARE
NY=========OtherMULTIPLAN NETWORK
=========OtherCAREPLUS