Organization
NORTHEASTERN LABORATORY MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODNEY H ROTHWELL MT(ASCP) (PRESIDENT)
(570) 459-0479
Entity
Organization
Contact information
Practice address
271 N CEDAR ST, HAZLETON, PA 18201-5551
(570) 459-0479
(570) 459-5230
Mailing address
271 N CEDAR ST, HAZLETON, PA 18201-5551
(570) 459-0479
(570) 459-5230
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
000776
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009004940002
—
PA
01
—
087355500
FEDERAL BLACK LUNG PROGRA
PA
01
—
300141
BLUE SHIELD
PA
Enumeration date
07/23/2006
Last updated
11/08/2010
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