Provider Demographics
NPI:1225380199
Name:EVIDIA BIOSCIENCES INC - PA
Entity Type:Organization
Organization Name:EVIDIA BIOSCIENCES INC - PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, ADMINISTRATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-861-2000
Mailing Address - Street 1:995 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:310
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1709
Mailing Address - Country:US
Mailing Address - Phone:484-580-8836
Mailing Address - Fax:
Practice Address - Street 1:995 OLD EAGLE SCHOOL RD
Practice Address - Street 2:310
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1709
Practice Address - Country:US
Practice Address - Phone:484-580-8836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVIDIA BIOSCIENCES INC - CA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032383291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory