1740353853 NPI number — CYTOGENX CORP

Table of content: (NPI 1740353853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740353853 NPI number — CYTOGENX CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYTOGENX CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740353853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11790-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-751-0212
Provider Business Mailing Address Fax Number:
631-751-0944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 ROUTE 25A
Provider Second Line Business Practice Location Address:
SUITE # 1C
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-751-0212
Provider Business Practice Location Address Fax Number:
631-751-0944
Provider Enumeration Date:
11/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
631-751-0212

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  7948 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 800026179 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008025569 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0249360 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02211796 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001891800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".