1205215597 NPI number — PROSYNTHESIS LABORATORIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205215597 NPI number — PROSYNTHESIS LABORATORIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSYNTHESIS LABORATORIES, 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:
6
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:
1205215597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45975 NOKES BLVD
Provider Second Line Business Mailing Address:
STE 170
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20166-6554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-430-2221
Provider Business Mailing Address Fax Number:
703-430-8886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45975 NOKES BLVD
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20166-6554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-430-2221
Provider Business Practice Location Address Fax Number:
703-430-8886
Provider Enumeration Date:
05/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KRACHENFELS
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-625-1000

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com