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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