Lab Source One LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LAB SOURCE ONE LLC

Practice address

132 32ND St Ste 210
Brooklyn, NY 11232-1833

Phone

(929) 539-6804

NPI assigned

Aug 2, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Stanislav Grinberg, PHD

Title

Lab Director

Phone

(929) 539-6804

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1912634874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 32ND ST STE 210",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112321833",
            "telephone_number": "929-539-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 32ND ST STE 210",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112321833",
            "telephone_number": "929-539-6804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAB SOURCE ONE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "GRINBERG",
        "authorized_official_first_name": "STANISLAV",
        "authorized_official_title_or_position": "LAB DIRECTOR",
        "authorized_official_telephone_number": "929-539-6804",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; 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.