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General NPI Number Information
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NPI Number | 1689210197
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Entity Type | Organization
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Legal Business Name | NEOGENIX, PC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 16147 LANCASTER HWY STE 140
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City | CHARLOTTE
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State | NC
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Zip | 28277-4782
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Country | US
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Telephone | 518-577-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 10109 VICTORIA MILL CT
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City | CHARLOTTE
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State | NC
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Zip | 28277-2146
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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 | MANAGEMENT COMPANY
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Name | MR. NIKITAS WILLIAM MILES
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Credential |
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Telephone | 518-577-7506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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