Provider Demographics
NPI:1568008118
Name:ENZO CLINICAL LABS, INC.
Entity Type:Organization
Organization Name:ENZO CLINICAL LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-715-3266
Mailing Address - Street 1:60 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4710
Mailing Address - Country:US
Mailing Address - Phone:631-755-5500
Mailing Address - Fax:
Practice Address - Street 1:4 CORPORATE DR STE 283
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6211
Practice Address - Country:US
Practice Address - Phone:203-513-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENZO BIOCHEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-19
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory