1417296955 NPI number — GENOSCIENTIFIC LLC

Table of content: (NPI 1417296955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417296955 NPI number — GENOSCIENTIFIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENOSCIENTIFIC LLC
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:
GENOSCIENTIFIC LLC
Provider Other Organization Name Type Code:
4
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:
1417296955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 ETHEL RD
Provider Second Line Business Mailing Address:
SUITE 203C
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08817-2839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-662-5543
Provider Business Mailing Address Fax Number:
732-662-5544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4270 RT 1 N
Provider Second Line Business Practice Location Address:
SUITE-1
Provider Business Practice Location Address City Name:
MONMOUTH JUNCTION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08852-2376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
173-264-2113
Provider Business Practice Location Address Fax Number:
732-662-5544
Provider Enumeration Date:
02/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
SUVAS
Authorized Official Middle Name:
B
Authorized Official Title or Position:
LAB DIRECTOR
Authorized Official Telephone Number:
732-642-1133

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  25MS00010500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 31D1095378 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: CQP46267 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 21882 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 36D2069756 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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