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General NPI Number Information
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NPI Number | 1699938977
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Entity Type | Organization
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Legal Business Name | MEDIX LABS INC
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 500 ST. GEORGE ROAD
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City | STATEN ISLAND
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State | NY
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Zip | 10306
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Country | US
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Telephone | 646-372-5087
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ST. GEORGE ROAD C/O GEORGE MELKADZE
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City | STATEN ISLAND
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State | NY
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Zip | 10306
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Country | US
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Telephone | 646-372-5087
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. GEORGE MELKADZE
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Credential |
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Telephone | 646-372-5087
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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 | 211683-1
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License Number State | NY
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