Provider Demographics
NPI:1740353853
Name:CYTOGENX CORP
Entity type:Organization
Organization Name:CYTOGENX CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-751-0212
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1919
Mailing Address - Country:US
Mailing Address - Phone:631-751-0212
Mailing Address - Fax:631-751-0944
Practice Address - Street 1:1212 ROUTE 25A
Practice Address - Street 2:SUITE # 1C
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1919
Practice Address - Country:US
Practice Address - Phone:631-751-0212
Practice Address - Fax:631-751-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7948291U00000X
FL800026179291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008025569Medicaid
NJ0249360Medicaid
NY02211796Medicaid
FL001891800Medicaid
A30023230Medicare PIN