State Scientific Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

STATE SCIENTIFIC LAB LLC

Practice address

1550 N Mannheim Rd Ste C
Stone Park, IL 60165-1300

Phone

(708) 223-0457

NPI assigned

Oct 22, 2021

Last updated

Nov 5, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fahad Gaffoor

Title

President

Phone

(773) 818-5550

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636070400000",
    "number": "1447914874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N MANNHEIM RD STE C",
            "city": "STONE PARK",
            "state": "IL",
            "postal_code": "601651300",
            "telephone_number": "708-223-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 N MANNHEIM RD STE C",
            "city": "STONE PARK",
            "state": "IL",
            "postal_code": "601651300",
            "telephone_number": "708-223-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE SCIENTIFIC LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A",
        "authorized_official_last_name": "GAFFOOR",
        "authorized_official_first_name": "FAHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-818-5550"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Stone Park, IL
• Providers in Stone Park, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; 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.