Healthcare Provider Details

I. General information

NPI: 1114599842
Provider Name (Legal Business Name): BIORUSH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 JOHNSON AVE STE PR1N
BRONX NY
10463-1617
US

IV. Provider business mailing address

3640 JOHNSON AVE STE PR1N
BRONX NY
10463-1617
US

V. Phone/Fax

Practice location:
  • Phone: 914-510-2415
  • Fax:
Mailing address:
  • Phone: 914-510-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: LAURA LEE GAYLE
Title or Position: DIRECTOR OF MEDICAL LOGISTICS
Credential: RN
Phone: 914-510-2415