Healthcare Provider Details

I. General information

NPI: 1700420361
Provider Name (Legal Business Name): RENALYTIX AI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30-02 48TH AVE. SUITE 150
LONG ISLAND CITY NY
11101-3432
US

IV. Provider business mailing address

PO BOX 2460
CAROL STREAM IL
60132-2460
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-3970
  • Fax:
Mailing address:
  • Phone: 480-861-1383
  • Fax: 201-345-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES MCCULLOUGH
Title or Position: CEO
Credential:
Phone: 888-203-2725