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General NPI Number Information
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NPI Number | 1396170924
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Entity Type | Organization
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Legal Business Name | CYTONICS CORPORATION
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 555 HERITAGE DR SUITE 115
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City | JUPITER
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State | FL
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Zip | 33458-5285
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Country | US
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Telephone | 561-575-4451
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Fax | 561-257-0752
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Provider Business Mailing Address
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Address Line | 555 HERITAGE DR SUITE 115
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City | JUPITER
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State | FL
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Zip | 33458-5285
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Country | US
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Telephone | 561-575-4451
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Fax | 561-257-0752
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND B JOHNSON
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Credential |
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Telephone | 561-575-4451
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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 | 8000025822
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License Number State | FL
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