Healthcare Provider Details

I. General information

NPI: 1710127279
Provider Name (Legal Business Name): NEOGENOMICS LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9548 TOPANGA CANYON BLVD
CHATSWORTH CA
91311-4011
US

IV. Provider business mailing address

PO BOX 864110
ORLANDO FL
32886-4110
US

V. Phone/Fax

Practice location:
  • Phone: 866-776-5907
  • Fax: 818-700-1871
Mailing address:
  • Phone: 866-776-5907
  • Fax: 239-690-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF337277
License Number StateCA

VIII. Authorized Official

Name: ROBERT P GASPARINI
Title or Position: PRESIDENT
Credential:
Phone: 866-776-5907