Healthcare Provider Details

I. General information

NPI: 1235234402
Provider Name (Legal Business Name): ENZO CLINICAL LABS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EXECUTIVE BLVD
FARMINGDALE NY
11735-4710
US

IV. Provider business mailing address

60 EXECUTIVE BLVD
FARMINGDALE NY
11735-4710
US

V. Phone/Fax

Practice location:
  • Phone: 631-755-5566
  • Fax: 631-755-5566
Mailing address:
  • Phone: 631-755-5500
  • Fax: 631-755-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number21685150A050
License Number StateNY

VIII. Authorized Official

Name: DR. DIETER SCHAPFEL
Title or Position: CHIEF SCIENTIFIC OFFICER/MEDICAL DI
Credential: M.D.
Phone: 631-755-5500