Provider Demographics
NPI:1437960549
Name:LABORATORY EXCELLENCE CONCIERGE SERVICES LLC
Entity type:Organization
Organization Name:LABORATORY EXCELLENCE CONCIERGE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILYASAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:609-405-5974
Mailing Address - Street 1:890 E WALNUT RD APT 38
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5040
Mailing Address - Country:US
Mailing Address - Phone:609-405-5974
Mailing Address - Fax:
Practice Address - Street 1:115 PHILADELPHIA AVE
Practice Address - Street 2:STE B #224
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215
Practice Address - Country:US
Practice Address - Phone:856-202-6243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty