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General NPI Number Information
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NPI Number | 1831343383
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Entity Type | Organization
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Legal Business Name | GENETIC DIAGNOSTIC LABORATORY
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 3620 HAMILTON WALK 415 ANATOMY-CHEMSTRY BUILDING
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4215
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Country | US
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Telephone | 215-573-9161
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Fax | 215-573-5940
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Provider Business Mailing Address
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Address Line | 415 CURIE BOULEVARD 415 ANATOMY-CHEMISTRY BUILDING-DEPARTMENT OF GENETICS
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-573-9161
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Fax | 215-573-5940
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. ARUPA GANGULY
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Credential | PH.D.
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Telephone | 215-898-3122
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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 | 39D0893887
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License Number State | PA
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