Organization
STATE OF NEW YORK
Active
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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