Ace Clinical Laboratory, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

PFI4386 Issued in NY

Legal business name

ACE CLINICAL LABORATORY, INC

Practice address

283 Commack Road
Suite 204
Commack, NY 11725

Phone

(631) 462-4400

Fax

(631) 462-3431

NPI assigned

Nov 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Willowmenia Isdora Costa

Title

President

Phone

(631) 462-4400

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1235208992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 COMMACK ROAD",
            "address_2": "SUITE 315",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "11725",
            "telephone_number": "631-462-4400",
            "fax_number": "631-462-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 COMMACK ROAD",
            "address_2": "SUITE 204",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "11725",
            "telephone_number": "631-462-4400",
            "fax_number": "631-462-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACE CLINICAL LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "WILLOWMENIA",
        "authorized_official_middle_name": "ISDORA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-462-4400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "PFI4386",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "CLIA33D0674863",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01350994",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.