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General NPI Number Information
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NPI Number | 1235477795
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Entity Type | Organization
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Legal Business Name | GENO-PATH DIAGNOSTIC LABS, INC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 211 WESTWOOD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5414
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Country | US
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Telephone | 631-579-7158
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Fax |
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Provider Business Mailing Address
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Address Line | 211 WESTWOOD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5414
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Country | US
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Telephone | 631-579-7158
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ZUJIN LI
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Credential | MD
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Telephone | 631-579-7158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 8707
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License Number State | NY
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