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General NPI Number Information
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NPI Number | 1740353853
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Entity Type | Organization
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Legal Business Name | CYTOGENX CORP
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 1212 ROUTE 25A SUITE # 1C
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City | STONY BROOK
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State | NY
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Zip | 11790-1919
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Country | US
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Telephone | 631-751-0212
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Fax | 631-751-0944
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | STONY BROOK
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State | NY
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Zip | 11790-1919
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Country | US
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Telephone | 631-751-0212
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Fax | 631-751-0944
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Authorized Official
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Title or Position | CEO
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Name | DR. TERESA DUNN
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Credential | PHD
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Telephone | 631-751-0212
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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 | 800026179
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 7948
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License Number State | NY
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