Provider Demographics
NPI:1740651173
Name:CANCER GENETICS INC
Entity type:Organization
Organization Name:CANCER GENETICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:SITAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-528-9200
Mailing Address - Street 1:201 ROUTE 17 NORTH
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2597
Mailing Address - Country:US
Mailing Address - Phone:201-528-9200
Mailing Address - Fax:201-528-9201
Practice Address - Street 1:1640 MARENGO STREET
Practice Address - Street 2:7TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1057
Practice Address - Country:US
Practice Address - Phone:323-224-3900
Practice Address - Fax:323-224-3906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER GENETICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 335062291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory