Provider Demographics
NPI:1548974157
Name:ICON LABS INC.
Entity type:Organization
Organization Name:ICON LABS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-854-8971
Mailing Address - Street 1:5944 CORAL RIDGE DR # 246
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3300
Mailing Address - Country:US
Mailing Address - Phone:954-854-8971
Mailing Address - Fax:
Practice Address - Street 1:4891 NW 103RD AVE STE 11J
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7955
Practice Address - Country:US
Practice Address - Phone:954-854-8971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty