Healthcare Provider Details

I. General information

NPI: 1831702521
Provider Name (Legal Business Name): EXPRESS INFECTIOUS VIRUSES TESTING LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 SEDGWICK AVE APT 1B
BRONX NY
10468-2458
US

IV. Provider business mailing address

2755 SEDGWICK AVE APT 1B
BRONX NY
10468-2458
US

V. Phone/Fax

Practice location:
  • Phone: 914-573-4086
  • Fax:
Mailing address:
  • Phone: 914-573-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS FERREIRA
Title or Position: PRESIDENT
Credential:
Phone: 914-573-4086