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BROOKSIDE CLINICAL LABORATORY INC NPI 1629047436


NPI Information

NPI: 1629047436
Provider Name: BROOKSIDE CLINICAL LABORATORY INC
Classification: Clinical Medical Laboratory - 291U00000X
Entity Type: Organization

CLIA Number: 39D0195442

Address:
2901 DUTTON MILL RD STE 100
ASTON, PA
ZIP 19014
Phone: (610) 872-6466
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BROOKSIDE CLINICAL LABORATORY INC is a clinical medical laboratory in Aston, PA. 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. BROOKSIDE CLINICAL LABORATORY INC NPI is 1629047436. The provider is registered as an organization entity type.

The provider's business location address is:

2901 DUTTON MILL RD STE 100
ASTON, PA
ZIP 19014-850
Phone: (610) 872-6466
Fax: (610) 872-7628

The provider's authorized official is John J Iacono .
The authorized official title is Owner Director and has the following contact phone number (610) 872-6466.

The CLIA number assigned to this NPI record is 39D0195442 - independent with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 3/15/2006 and was last updated on 11/6/2018.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1291U00000XClinical Medical LaboratoryPA000472PENNSYLVANIAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1398126OTHERRAILROAD TRAVELERS
20007670710001MEDICAIDPENNSYLVANIA
3398126OTHERBLUE SHIELD
48034907MEDICAIDNEW JERSEY
50000991109MEDICAIDDELAWARE

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: 5/5/2024

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