Contract Details
Facility name
Interscience Laboratory Inc
Provider ID
P000003885
NPI
1134213598
Tax ID
133377201
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1750 Richmond Ave
Staten Island, NY 10314
United States
County
Richmond
Phone
7186985461 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address