MEDICARE: FALCON GENOMICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39D2088138	OTHER	PA	CLIA

General Provider Information

NPI Number	:	1467844738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALCON GENOMICS INC

Provider Business Mailing Address
First Line	:	3 PENN CTR W
Second Line	:	SUITE 127
City	:	PITTSBURGH
State	:	PA
Zip	:	15276-0103
Country	:	US
Telephone Number	:	412-788-4995
Fax Number	:	412-788-0250

Provider Business Practice Location Address
First Line	:	2661 CLEARVIEW RD
Second Line	:	SUITE 1
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-3180
Country	:	US
Telephone Number	:	412-788-4995
Fax Number	:	412-788-0250

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	RULA ABBUD-ANTAKI
Credential	:
Telephone Number	:	412-334-9240

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/24/2015

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