Provider Demographics
NPI:1659672004
Name:ESOTERIX GENETIC LABORATORIES, LLC
Entity Type:Organization
Organization Name:ESOTERIX GENETIC LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-7566
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2240
Mailing Address - Country:US
Mailing Address - Phone:800-222-7566
Mailing Address - Fax:336-436-1048
Practice Address - Street 1:533 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2901
Practice Address - Country:US
Practice Address - Phone:212-698-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
33D0653384OtherCLIA