Provider Demographics
NPI:1205215597
Name:PROSYNTHESIS LABORATORIES, INC.
Entity Type:Organization
Organization Name:PROSYNTHESIS LABORATORIES, INC.
Other - Org Name:UNJURY PROTEIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:KRACHENFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-625-1000
Mailing Address - Street 1:45975 NOKES BLVD
Mailing Address - Street 2:STE 170
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6554
Mailing Address - Country:US
Mailing Address - Phone:703-430-2221
Mailing Address - Fax:703-430-8886
Practice Address - Street 1:45975 NOKES BLVD
Practice Address - Street 2:STE 170
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6554
Practice Address - Country:US
Practice Address - Phone:703-430-2221
Practice Address - Fax:703-430-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition