Basic Information
| Provider Information | |||||||||
| NPI: | 1316389158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SJ PENNJE LABORATORY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3205 FIRE RD | ||||||||
| Address2: | SUITE P1 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094071220 | ||||||||
| FaxNumber: | 6096775489 | ||||||||
| Practice Location | |||||||||
| Address1: | 3205 FIRE RD | ||||||||
| Address2: | SUITE P1 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094071220 | ||||||||
| FaxNumber: | 6096775489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2013 | ||||||||
| LastUpdateDate: | 07/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | ABDULLA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6094071220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, FCAP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.