Organization
INTERPACE DIAGNOSTICS LAB, INC.
Active
Organization
INTERPACE DIAGNOSTICS LAB, INC.
Active
Other names
JS Genetics, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GRAHAM MIAO (CFO)
(862) 207-7824
Entity
Organization
Contact information
Practice address
2 CHURCH ST S, SUITE B-05, NEW HAVEN, CT 06519-1717
(203) 252-3558
(203) 624-5742
Mailing address
2 CHURCH ST S, SUITE B-05, NEW HAVEN, CT 06519-1717
(203) 252-3558
(203) 624-5742
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
CL-0664
CT
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07D1091103
CLIA
CT
01
—
D300076340
MEDICARE PTAN
—
Enumeration date
12/06/2010
Last updated
04/22/2015
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