Organization · NPI-2
Monmouth Tissue Laboratory, LLC
Clinical Medical Laboratory · Eatontown, NJ
NPI number1467740936
StatusActive
Last updated in NPPESJul 18, 2011
Details
- NPI
- 1467740936
- Entity type
- Organization (NPI-2)
- Legal business name
- Monmouth Tissue Laboratory, LLC
- Organization subpart
- No
- Enumeration date
- Jul 18, 2011
- Last updated
- Jul 18, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291U00000X | Clinical Medical Laboratory | – | – | Yes |
Practice location
10 Industrial Way ESuite 110
Eatontown, NJ 07724-3332
Phone 732-460-2838
Mailing address
142 Highway 35Suite 206
Eatontown, NJ 07724-1876
Phone 732-460-2838 · Fax 732-460-2843
Authorized official
David Portman
Owner
7323891531
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