MEDICARE: CANCER GENETICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	CLF 335062	CA

General Provider Information

NPI Number	:	1740651173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER GENETICS INC

Provider Business Mailing Address
First Line	:	201 ROUTE 17 NORTH
Second Line	:	2ND FLOOR
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2597
Country	:	US
Telephone Number	:	201-528-9200
Fax Number	:	201-528-9201

Provider Business Practice Location Address
First Line	:	1640 MARENGO STREET
Second Line	:	7TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1057
Country	:	US
Telephone Number	:	323-224-3900
Fax Number	:	323-224-3906

Authorized Official
Title or Position	:	CFO
Name	:	MR. ED SITAR
Credential	:
Telephone Number	:	201-528-9200

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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