Basic Information
| Provider Information | |||||||||
| NPI: | 1902824964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS CLINICAL LABORATORIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 PLAZA DR | ||||||||
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| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070943619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002220446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2423 SAND LAKE RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328097641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666978378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOWLES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8666978378 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS INCORPORATED | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 10D0274847 | FL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.