Organization
SOPHORA DIAGNOSTIC LAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKHAIL I KANTIUS (PRESIDENT OWNER)
(718) 969-2884
Entity
Organization
Contact information
Practice address
79-18 164 ST, JAMAICA, NY 11432
(718) 969-2884
(718) 969-2576
Mailing address
PO BOX 740048, REGO PARK, NY 11374
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
01/10/2006
Last updated
08/22/2007
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