Provider Demographics
NPI:1497486880
Name:ADVANTAGE DIAGNOSTICS CLINICAL LABORATORY LLC
Entity Type:Organization
Organization Name:ADVANTAGE DIAGNOSTICS CLINICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-632-2681
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07602-0429
Mailing Address - Country:US
Mailing Address - Phone:732-965-7870
Mailing Address - Fax:
Practice Address - Street 1:B3 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3361
Practice Address - Country:US
Practice Address - Phone:732-965-7870
Practice Address - Fax:732-856-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory