Provider Demographics
NPI:1447314513
Name:AMMON ANALYTICAL LABORATORIES LLC
Entity type:Organization
Organization Name:AMMON ANALYTICAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:AMMON
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-862-4404
Mailing Address - Street 1:35 E BLANCKE ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-862-4404
Mailing Address - Fax:908-583-9997
Practice Address - Street 1:35 E BLANCKE ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-862-4404
Practice Address - Fax:908-583-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00042568291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7868707Medicaid
NJ23125Medicare ID - Type Unspecified