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General NPI Number Information
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NPI Number | 1467793208
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Entity Type | Organization
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Legal Business Name | CGC GENETICS INC.
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 185 S ORANGE AVE F661
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City | NEWARK
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State | NJ
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Zip | 07103-2757
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Country | US
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Telephone | 973-623-1264
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Fax | 973-623-1266
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Provider Business Mailing Address
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Address Line | 185 S ORANGE AVE F661
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City | NEWARK
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State | NJ
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Zip | 07103-2757
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Country | US
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Telephone | 973-623-1264
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Fax | 973-623-1266
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Authorized Official
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Title or Position | CEO
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Name | PROF. PURIFICACAO TAVARES
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Credential | M.D., PHD
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Telephone | 973-623-1264
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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 | COS00800249
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License Number State | CA
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