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General NPI Number Information
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NPI Number | 1700240405
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Entity Type | Organization
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Legal Business Name | PHOSPHORUS DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 400 PLAZA DR FL 4
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City | SECAUCUS
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State | NJ
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Zip | 07094-3605
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Country | US
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Telephone | 646-470-7422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4668 #29926
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City | NEW YORK
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State | NY
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Zip | 10163-4668
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Country | US
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Telephone | 646-470-7422
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEXANDER BISIGNANO
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Credential |
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Telephone | 855-746-7423
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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 |
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License Number State |
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