Provider Demographics
NPI:1174517353
Name:ACM MEDICAL LABORATORY INC
Entity type:Organization
Organization Name:ACM MEDICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:GITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-429-2225
Mailing Address - Street 1:160 ELMGROVE PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1359
Mailing Address - Country:US
Mailing Address - Phone:585-429-2289
Mailing Address - Fax:585-247-2797
Practice Address - Street 1:160 ELMGROVE PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1359
Practice Address - Country:US
Practice Address - Phone:585-429-2289
Practice Address - Fax:585-247-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00419750Medicaid
NY14989BMedicare ID - Type Unspecified