Provider Demographics
NPI:1043869068
Name:CHAMPLAIN TOXICOLOGY LAB, LLC
Entity type:Organization
Organization Name:CHAMPLAIN TOXICOLOGY LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THIERRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BONNABESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-324-7246
Mailing Address - Street 1:32 VETERANS LN STE 2
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1223
Mailing Address - Country:US
Mailing Address - Phone:518-324-1698
Mailing Address - Fax:
Practice Address - Street 1:32 VETERANS LN STE 2
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1217
Practice Address - Country:US
Practice Address - Phone:518-324-5261
Practice Address - Fax:518-324-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory