Provider Demographics
NPI:1679958573
Name:ANY LAB DRAW NOW LLC
Entity type:Organization
Organization Name:ANY LAB DRAW NOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:ANNMARIE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-448-9698
Mailing Address - Street 1:64 LAMBERT AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1737
Mailing Address - Country:US
Mailing Address - Phone:617-448-9698
Mailing Address - Fax:
Practice Address - Street 1:64 LAMBERT AVE
Practice Address - Street 2:APT 1
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1737
Practice Address - Country:US
Practice Address - Phone:617-448-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service