=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043786312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3P OMICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2018
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 FOREST LN
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-380-6695
-----------------------------------------------------
Fax | 844-329-6766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 MCKINNEY ST STE 11977
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77002-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-777-5566
-----------------------------------------------------
Fax | 844-329-6766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LABORATORY DIRECTOR
-----------------------------------------------------
Name | DR. GIDON AKLER
-----------------------------------------------------
Credential | MD, FACMG
-----------------------------------------------------
Telephone | 832-777-5566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QG0250X
-----------------------------------------------------
Taxonomy Name | Genetics Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------