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General NPI Number Information
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NPI Number | 1265853519
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Entity Type | Organization
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Legal Business Name | EMPIRE GENOMICS, LLC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 700 MICHIGAN AVE SUITE 200
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City | BUFFALO
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State | NY
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Zip | 14203-1536
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Country | US
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Telephone | 716-856-3873
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Fax | 716-856-3857
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Provider Business Mailing Address
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Address Line | 700 MICHIGAN AVE SUITE 200
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City | BUFFALO
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State | NY
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Zip | 14203-1536
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ANTHONY JOHNSON
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Credential |
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Telephone | 716-856-3873
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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 | LAP72132
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License Number State | NY
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