Provider Demographics
NPI:1114696101
Name:VIDHATA GENOMICS LLC
Entity Type:Organization
Organization Name:VIDHATA GENOMICS LLC
Other - Org Name:VIDHATA GENOMICS
Other - Org Type:Other Name
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-642-1133
Mailing Address - Street 1:4270 RT 1 NORTH
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852
Mailing Address - Country:US
Mailing Address - Phone:732-642-1133
Mailing Address - Fax:
Practice Address - Street 1:4270 RT 1 NORTH
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852
Practice Address - Country:US
Practice Address - Phone:732-642-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1N1364Medicaid