Provider Demographics
NPI:1184255606
Name:EXPRESS GENE LLC
Entity type:Organization
Organization Name:EXPRESS GENE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:FAGHIHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:786-250-3419
Mailing Address - Street 1:9000 SW 152ND STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:786-250-3419
Mailing Address - Fax:786-250-3074
Practice Address - Street 1:9000 SW 152ND ST STE 209
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1942
Practice Address - Country:US
Practice Address - Phone:786-250-3419
Practice Address - Fax:786-250-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory