Provider Demographics
NPI:1780010272
Name:GENQUEST DNA ANALYSIS LABORATORY
Entity Type:Organization
Organization Name:GENQUEST DNA ANALYSIS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JEOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-358-0652
Mailing Address - Street 1:133 CONEY ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6317
Mailing Address - Country:US
Mailing Address - Phone:775-358-0652
Mailing Address - Fax:
Practice Address - Street 1:133 CONEY ISLAND DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6317
Practice Address - Country:US
Practice Address - Phone:775-358-0652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20031054361291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory