NPIMap

Organization Active NPI

State of New York

  • Clinical Medical Laboratory
  • Staten Island, NY
National Provider Identifier
1962579235
Registry record updated Feb 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
7097M040 Issued in NY
Legal business name
STATE OF NEW YORK
Practice address
1050 Forest Hill Rd
Staten Island, NY 10314-6356
Phone
(718) 494-5345
Fax
(718) 494-0694
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2009

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

Authorized official

Name
Dr. Edmund C. Jenkins, PHD
Title
Lab Director
Phone
(718) 494-5236

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 7097M040 NY Primary

Addresses

Primary practice location

1050 Forest Hill Rd
Staten Island, NY 10314-6356

Mailing address

1050 Forest Hill Rd
Staten Island, NY 10314-6356
Phone (718) 494-5345

Other identifiers 3

IdentifierTypeStateIssuer
33D0860102OtherCLIA
00782518MedicaidNY
7097M040OtherNYNYS LAB LICENSE

Other names 1

  • IBR Specialty Clinical Laboratories Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0860102Ibr Specialty Clinical Laboratories1050 Forest Hill Road, Staten Island, NY 10314ComplianceMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Daniel a Spengler269 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1962579235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 FOREST HILL RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146356",
            "telephone_number": "718-494-5345",
            "fax_number": "718-494-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 FOREST HILL RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146356",
            "telephone_number": "718-494-5345",
            "fax_number": "718-494-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "EDMUND",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "LAB DIRECTOR",
        "authorized_official_telephone_number": "718-494-5236",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "7097M040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "33D0860102",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00782518",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LAB LICENSE",
            "identifier": "7097M040",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IBR Specialty Clinical Laboratories",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.