1962641563 NPI number — ROSETTA GENOMICS, INC.

Table of content: (NPI 1962641563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962641563 NPI number — ROSETTA GENOMICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSETTA GENOMICS, 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:
1962641563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11979
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07101-4979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-522-7971
Provider Business Mailing Address Fax Number:
215-382-0815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3711 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 740
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-382-9000
Provider Business Practice Location Address Fax Number:
215-382-0815
Provider Enumeration Date:
02/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BERLIN
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
888-522-7971

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  030877 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 210242 . This is a "HIGHMARK MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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