Provider Demographics
NPI:1356656862
Name:CORIELL INSTITUTE FOR MEDICAL RESEARCH
Entity Type:Organization
Organization Name:CORIELL INSTITUTE FOR MEDICAL RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PALLIES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:856-757-4826
Mailing Address - Street 1:403 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1505
Mailing Address - Country:US
Mailing Address - Phone:856-966-7377
Mailing Address - Fax:856-964-0254
Practice Address - Street 1:403 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1505
Practice Address - Country:US
Practice Address - Phone:856-966-7377
Practice Address - Fax:856-964-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00015734291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory