Provider Demographics
NPI:1780983023
Name:BRLI - GENPATH DIAGNOSTICS, INC
Entity type:Organization
Organization Name:BRLI - GENPATH DIAGNOSTICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-2600
Mailing Address - Street 1:481 EDWARD H ROSS DR
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3118
Mailing Address - Country:US
Mailing Address - Phone:201-791-2600
Mailing Address - Fax:
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:201-791-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOREFERENCE LABORATORIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-25
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Single Specialty