Provider Demographics
NPI:1235671884
Name:CERNOSTICS, INC.
Entity Type:Organization
Organization Name:CERNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAETZOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-974-1551
Mailing Address - Street 1:2014 SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5913
Mailing Address - Country:US
Mailing Address - Phone:866-788-9007
Mailing Address - Fax:
Practice Address - Street 1:100 S COMMONS STE 245
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5359
Practice Address - Country:US
Practice Address - Phone:866-788-9007
Practice Address - Fax:855-929-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34818291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory