Provider Demographics
NPI:1962641563
Name:ROSETTA GENOMICS, INC.
Entity Type:Organization
Organization Name:ROSETTA GENOMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-522-7971
Mailing Address - Street 1:PO BOX 11979
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4979
Mailing Address - Country:US
Mailing Address - Phone:888-522-7971
Mailing Address - Fax:215-382-0815
Practice Address - Street 1:3711 MARKET ST
Practice Address - Street 2:SUITE 740
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5504
Practice Address - Country:US
Practice Address - Phone:215-382-9000
Practice Address - Fax:215-382-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030877291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA210242OtherHIGHMARK MEDICARE