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Contact Information

JOHN IACONO, BSC
4000 EDGMONT AVE
BROOKSIDE CLINICAL LABORATORY
BROOKHAVEN, PA19015
 Phone: 610-872-6466
 Fax: 610-872-7628
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
Indicates primary specialty

NPI Profile & details for JOHN IACONO · (Male)

NPI Number 1013084722
Status Active
Credentials BSC
Entity Individual
Enumeration date 11/29/2006
Last updated 07/08/2007 - About 12 years ago
Sole proprietor 1 Yes
Identifiers
  • DE Medicaid 0000991109
  • NJ Medicaid 8034907
  • PA Medicaid 000767071001
  • NJ Other 398126 BLUE SHIELD
  • PA Other 398126 BLUE SHIELD
  • PA Other 398126 RAILROAD TRAVELERS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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