Provider Demographics
NPI:1992315337
Name:JAYSON MOBILE CARE PHLEBOTOMIST LLC
Entity type:Organization
Organization Name:JAYSON MOBILE CARE PHLEBOTOMIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKTI
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANBODE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:973-820-7681
Mailing Address - Street 1:182 LITTLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2629
Mailing Address - Country:US
Mailing Address - Phone:973-820-7681
Mailing Address - Fax:973-528-2558
Practice Address - Street 1:80 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-6914
Practice Address - Country:US
Practice Address - Phone:973-866-7453
Practice Address - Fax:973-528-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory