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STATE OF NEW YORK NPI 1962579235


NPI Information

NPI: 1962579235
Provider Name: STATE OF NEW YORK

Other Name: IBR SPECIALTY CLINICAL LABORATORIES

Classification: Clinical Medical Laboratory - 291U00000X
Entity Type: Organization

CLIA Number: 33D0860102

Address:
1050 FOREST HILL RD
STATEN ISLAND, NY
ZIP 10314
Phone: (718) 494-5345
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STATE OF NEW YORK is a clinical medical laboratory in Staten Island, NY. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. STATE OF NEW YORK NPI is 1962579235. The provider is registered as an organization entity type.
The provider Other Name Is Ibr Specialty Clinical Laboratories.

The provider's business location address is:

1050 FOREST HILL RD
STATEN ISLAND, NY
ZIP 10314-356
Phone: (718) 494-5345
Fax: (718) 494-0694

The provider's authorized official is Edmund C. Jenkins .
The authorized official title is Lab Director and has the following contact phone number (718) 494-5236.

The CLIA number assigned to this NPI record is 33D0860102 - independent with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 2/25/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1291U00000XClinical Medical Laboratory7097M040NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
17097M040OTHERNEW YORKNYS LAB LICENSE
200782518MEDICAIDNEW YORK
333D0860102OTHERCLIA
433-8496MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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