Organization
ACE CLINICAL LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WILLOWMENIA ISDORA COSTA (PRESIDENT)
(631) 462-4400
Entity
Organization
Contact information
Practice address
283 COMMACK ROAD, SUITE 204, COMMACK, NY 11725
(631) 462-4400
(631) 462-3431
Mailing address
283 COMMACK ROAD, SUITE 315, COMMACK, NY 11725
(631) 462-4400
(631) 462-3431
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
CLIA33D0674863
NY
291U00000X
Clinical Medical Laboratory
Primary
PFI4386
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01350994
—
NY
Enumeration date
11/07/2006
Last updated
08/26/2015
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