=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861136350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RHEONIX LABORATORIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2022
-----------------------------------------------------
Last Update Date | 04/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 BROWN RD STE 1
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-257-1242
-----------------------------------------------------
Fax | 607-257-0979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 BROWN RD STE 1
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-257-1242
-----------------------------------------------------
Fax | 607-257-0979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. CHRISTOPHER SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-257-1242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------