Organization
PROST DATA INC
Active
Other names
OUR Lab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN OPPENHEIMER (OWNER)
(347) 628-4378
Entity
Organization
Contact information
Practice address
343 GOLD ST, 1412, BROOKLYN, NY 11201-3055
(347) 628-4378
(347) 521-1275
Mailing address
PO BOX 291209, NASHVILLE, TN 37229-1209
(615) 874-0410
(615) 345-4659
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
8504
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33D2004917
CLIA
—
Enumeration date
05/04/2010
Last updated
05/04/2010
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