Provider Demographics
NPI:1740546316
Name:EASTGENE LABORATORIES INC
Entity type:Organization
Organization Name:EASTGENE LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIBO
Authorized Official - Middle Name:
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-592-1268
Mailing Address - Street 1:4218 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4161
Mailing Address - Country:US
Mailing Address - Phone:718-463-4888
Mailing Address - Fax:718-463-4889
Practice Address - Street 1:4218 162ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4161
Practice Address - Country:US
Practice Address - Phone:718-463-4888
Practice Address - Fax:718-463-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-07
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory