Provider Demographics
NPI:1689210197
Name:NEOGENIX, PC
Entity Type:Organization
Organization Name:NEOGENIX, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT COMPANY
Authorized Official - Prefix:MR
Authorized Official - First Name:NIKITAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-577-7506
Mailing Address - Street 1:10109 VICTORIA MILL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16147 LANCASTER HWY STE 140
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4782
Practice Address - Country:US
Practice Address - Phone:518-577-7506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty