Organization
PROPHASE DIAGNOSTICS NY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROPHASE LABS, INC (OWNER)
(516) 464-6121
Entity
Organization
Contact information
Practice address
711 STEWART AVE, STE 200, GARDEN CITY, NY 11530-4719
(516) 464-6121
Mailing address
711 STEWART AVE STE 200, GARDEN CITY, NY 11530-4734
(516) 464-6121
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
07/22/2021
Last updated
11/16/2023
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