Organization
STATE OF NEW YORK
Active
Other names
IBR Specialty Clinical Laboratories
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDMUND C. JENKINS PHD (LAB DIRECTOR)
(718) 494-5236
Entity
Organization
Contact information
Practice address
1050 FOREST HILL RD, STATEN ISLAND, NY 10314-6356
(718) 494-5345
(718) 494-0694
Mailing address
1050 FOREST HILL RD, STATEN ISLAND, NY 10314-6356
(718) 494-5345
(718) 494-0694
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
7097M040
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00782518
—
NY
01
—
33D0860102
CLIA
—
01
—
7097M040
NYS LAB LICENSE
NY
Enumeration date
11/29/2006
Last updated
02/25/2009
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