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General NPI Number Information
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NPI Number | 1831770130
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Entity Type | Organization
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Legal Business Name | GENOLAB DIAGNOSTICS LLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 200 FAIRFIELD RD STE 22
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City | FAIRFIELD
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State | NJ
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Zip | 07004-2426
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Country | US
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Telephone | 973-287-6086
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Fax | 862-210-8569
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Provider Business Mailing Address
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Address Line | 200 FAIRFIELD RD STE 22
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City | FAIRFIELD
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State | NJ
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Zip | 07004-2426
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Country | US
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Telephone | 973-287-6086
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Fax | 862-210-8569
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Authorized Official
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Title or Position | CFO
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Name | ABDELRAHMAN AWAD
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Credential |
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Telephone | 973-287-6086
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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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