Brookside Clinical Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

PA000472 Issued in PA

Legal business name

BROOKSIDE CLINICAL LABORATORY INC

Practice address

2901 Dutton Mill Rd Ste 100
Aston, PA 19014-2850

Phone

(610) 872-6466

Fax

(610) 872-7628

NPI assigned

Mar 15, 2006

Last updated

Nov 6, 2018By 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

Mr. John J Iacono, BS

Title

Owner Director

Phone

(610) 872-6466

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Annette Iacono

  • Clinical Pathology/Laboratory Medicine Physician
  • Aston, PA
  • NPI 1881267110
  NPD
• Morgan Elizabeth Lindsay, MLS

  • Medical Laboratory Technician
  • Aston, PA
  • NPI 1912688011
  NPD (past)

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1629047436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 DUTTON MILL RD STE 100",
            "city": "ASTON",
            "state": "PA",
            "postal_code": "190142850",
            "telephone_number": "610-872-6466",
            "fax_number": "610-872-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 DUTTON MILL RD STE 100",
            "city": "ASTON",
            "state": "PA",
            "postal_code": "190142850",
            "telephone_number": "610-872-6466",
            "fax_number": "610-872-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE CLINICAL LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "IACONO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER DIRECTOR",
        "authorized_official_telephone_number": "610-872-6466",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "PA000472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8034907",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "398126",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007670710001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000991109",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD TRAVELERS",
            "identifier": "398126",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Aston, PA
• Providers in Aston, PA by specialty
• Clinical Medical Laboratory in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.