Provider Demographics
NPI:1942891312
Name:BASIS DIAGNOSTICS INC.
Entity Type:Organization
Organization Name:BASIS DIAGNOSTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREAS
Authorized Official - Middle Name:MATTHIAS
Authorized Official - Last Name:KOGELNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-776-4703
Mailing Address - Street 1:2688 MIDDLEFIELD RD STE A
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3483
Mailing Address - Country:US
Mailing Address - Phone:855-920-4522
Mailing Address - Fax:
Practice Address - Street 1:2688 MIDDLEFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3483
Practice Address - Country:US
Practice Address - Phone:855-920-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922113331OtherNPI