1760710586 NPI number — LIFECELL DX, INC

Table of content: DR. EKATERINA CASTANO MD (NPI 1902240518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760710586 NPI number — LIFECELL DX, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECELL DX, INC
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:
1760710586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4455 GENESEE ST
Provider Second Line Business Mailing Address:
SUITE 25
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-408-3306
Provider Business Mailing Address Fax Number:
716-608-1322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4455 GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-408-3306
Provider Business Practice Location Address Fax Number:
716-608-1322
Provider Enumeration Date:
12/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURKMAN
Authorized Official First Name:
LANI
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER / CHIEF SCIENCE OFFICER
Authorized Official Telephone Number:
716-408-3306

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  PFI # 8376 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PFI # 8376 . This is a "NEW YORK STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: # 33D 1088623 . This is a "CLIA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".