=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205834769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CBLPATH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2005
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 WESTCHESTER AVE
-----------------------------------------------------
City | RYE BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-698-5706
-----------------------------------------------------
Fax | 914-698-6624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 WASHINGTON AVE 2ND FLOOR
-----------------------------------------------------
City | NORTH HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06473-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-584-9406
-----------------------------------------------------
Fax | 203-985-2942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CIRIL C RIZK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 914-698-5706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 3954
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------