Provider Demographics
NPI:1699176768
Name:NEOGENOMICS LABORATORIES INC
Entity Type:Organization
Organization Name:NEOGENOMICS LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIRAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-776-5907
Mailing Address - Street 1:12701 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8626
Mailing Address - Country:US
Mailing Address - Phone:866-776-5907
Mailing Address - Fax:239-768-0711
Practice Address - Street 1:1 JENNER
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:866-776-5907
Practice Address - Fax:949-206-1865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOGENOMICS LABORATORIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-09
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00346265291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory