Organization
L2 DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK J MAMULA PH.D. (ASSOCIATE PROFESSOR OF MEDICINE)
(203) 785-2840
Entity
Organization
Contact information
Practice address
300 CEDAR ST. TAC ROOM S-525, NEW HAVEN, CT 06520-8031
(203) 737-1952
Mailing address
P.O. BOX 208031, 300 CEDAR ST. TAC ROOM S-525, NEW HAVEN, CT 06520-8031
(203) 737-1952
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07DO943606
CLIA
CT
01
—
709946
CT CARE
CT
01
—
A914266
OXFORD
CT
01
—
CU5316
HEALTHNET
CT
Enumeration date
12/14/2006
Last updated
08/22/2020
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