Basic Information
| Provider Information | |||||||||
| NPI: | 1275961641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN COMMUNITY LAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 W. VALLEY AVE. | ||||||||
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| City: | ELYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706721111 | ||||||||
| FaxNumber: | 5706721103 | ||||||||
| Practice Location | |||||||||
| Address1: | 454 W. VALLEY AVE. | ||||||||
| Address2: | |||||||||
| City: | ELYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706721111 | ||||||||
| FaxNumber: | 5706721103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | PUNIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8172878044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 33294 | PA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.