Provider Demographics
NPI:1518288596
Name:NEOGENESIS CENTER FOR WELLNESS AND ENT ALLERGY, PA
Entity Type:Organization
Organization Name:NEOGENESIS CENTER FOR WELLNESS AND ENT ALLERGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-691-7546
Mailing Address - Street 1:5952 ROYAL LN
Mailing Address - Street 2:STE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3862
Mailing Address - Country:US
Mailing Address - Phone:214-691-7546
Mailing Address - Fax:214-234-0053
Practice Address - Street 1:5952 ROYAL LN
Practice Address - Street 2:STE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3862
Practice Address - Country:US
Practice Address - Phone:214-691-7546
Practice Address - Fax:214-234-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2838207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty