Provider Demographics
NPI:1609491216
Name:AMEDIX
Entity Type:Organization
Organization Name:AMEDIX
Other - Org Name:AMEDIX LABORATORY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-628-5009
Mailing Address - Street 1:1841 82ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2292
Mailing Address - Country:US
Mailing Address - Phone:347-628-5009
Mailing Address - Fax:844-628-5009
Practice Address - Street 1:6103 STRICKLAND AVE STE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6408
Practice Address - Country:US
Practice Address - Phone:888-826-3349
Practice Address - Fax:888-826-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9533OtherPFI
NY33D2184128OtherCLIA