Provider Demographics
NPI:1417296955
Name:GENOSCIENTIFIC LLC
Entity Type:Organization
Organization Name:GENOSCIENTIFIC LLC
Other - Org Name:GENOSCIENTIFIC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUVAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-642-1133
Mailing Address - Street 1:2 ETHEL RD
Mailing Address - Street 2:SUITE 203C
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2839
Mailing Address - Country:US
Mailing Address - Phone:732-662-5543
Mailing Address - Fax:732-662-5544
Practice Address - Street 1:4270 RT 1 N
Practice Address - Street 2:SUITE-1
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2376
Practice Address - Country:US
Practice Address - Phone:173-264-2113
Practice Address - Fax:732-662-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MS00010500291U00000X
NJ31D1095378291U00000X
NJCQP46267291U00000X
MO21882291U00000X
OH36D2069756291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory