=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093756157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW SCHRYVER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12075 E 45TH AVE STE 700
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80239-3123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-650-5400
-----------------------------------------------------
Fax | 443-842-7264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 RIDGEBROOK RD FL 3
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21152-9481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-786-8015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL/CFO
-----------------------------------------------------
Name | BRIAN C CUOMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-786-8015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 02-74852-0000
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------