Provider Demographics
NPI:1235234402
Name:ENZO CLINICAL LABS, INC.
Entity Type:Organization
Organization Name:ENZO CLINICAL LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SCIENTIFIC OFFICER/MEDICAL DI
Authorized Official - Prefix:DR
Authorized Official - First Name:DIETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAPFEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-755-5500
Mailing Address - Street 1:60 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4710
Mailing Address - Country:US
Mailing Address - Phone:631-755-5500
Mailing Address - Fax:631-755-5566
Practice Address - Street 1:60 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4710
Practice Address - Country:US
Practice Address - Phone:631-755-5566
Practice Address - Fax:631-755-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21685150A050291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635754Medicaid
NY2026OtherHEALTHNET
0086442OtherGROUP HEALTH INC.
162350OtherELDER PLAN
690001935OtherMEDICARE RAILROAD
1000002976OtherAFFINITY HEALTH
EZNOCLINICALOtherCMO MONTEFIORE
NYEN0L807320Medicare ID - Type Unspecified