Organization
LIFELINE TESTS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB ROBERT PEACOCK MD (AUTHORIZED OFFICIAL)
(616) 894-1615
Entity
Organization
Contact information
Practice address
296 ATLANTIC AVE STE A, FREEPORT, NY 11520-4243
(616) 894-1615
Mailing address
296 ATLANTIC AVE STE A, FREEPORT, NY 11520-4243
(616) 894-1615
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
03/11/2025
Last updated
03/11/2025
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