Provider Demographics
NPI:1942684659
Name:SYNTEGRA SERVICES INC
Entity Type:Organization
Organization Name:SYNTEGRA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-551-1580
Mailing Address - Street 1:310 POILLON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5947
Mailing Address - Country:US
Mailing Address - Phone:212-634-1140
Mailing Address - Fax:718-551-1580
Practice Address - Street 1:310 POILLON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5947
Practice Address - Country:US
Practice Address - Phone:212-634-1140
Practice Address - Fax:718-551-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory