Healthcare Provider Details

I. General information

NPI: 1720363476
Provider Name (Legal Business Name): CGC GENETICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WARREN STREET SUITE 317
NEWARK NJ
07103
US

IV. Provider business mailing address

211 WARREN STREET SUITE 317
NEWARK NJ
07103
US

V. Phone/Fax

Practice location:
  • Phone: 877-242-5229
  • Fax: 973-623-1266
Mailing address:
  • Phone: 877-242-5229
  • Fax: 973-623-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNJ

VIII. Authorized Official

Name: PETER TOLIAS
Title or Position: CHIEF BUSINESS & SCIENTIFIC CONSULT
Credential: PH.D.
Phone: 877-242-5229