Healthcare Provider Details

I. General information

NPI: 1417296955
Provider Name (Legal Business Name): GENOSCIENTIFIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 03/16/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 RT 1 N SUITE-1
MONMOUTH JUNCTION NJ
08852-2376
US

IV. Provider business mailing address

2 ETHEL RD SUITE 203C
EDISON NJ
08817-2839
US

V. Phone/Fax

Practice location:
  • Phone: 173-264-2113
  • Fax: 732-662-5544
Mailing address:
  • Phone: 732-662-5543
  • Fax: 732-662-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number31D1095378
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCQP46267
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number21882
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36D2069756
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number25MS00010500
License Number StateNJ

VIII. Authorized Official

Name: DR. SUVAS B DESAI
Title or Position: LAB DIRECTOR
Credential: PHD
Phone: 732-642-1133