Provider Demographics
NPI:1831770130
Name:GENOLAB DIAGNOSTICS LLC
Entity type:Organization
Organization Name:GENOLAB DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ABDELRAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-287-6086
Mailing Address - Street 1:200 FAIRFIELD RD STE 22
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2426
Mailing Address - Country:US
Mailing Address - Phone:973-287-6086
Mailing Address - Fax:862-210-8569
Practice Address - Street 1:200 FAIRFIELD RD STE 22
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2426
Practice Address - Country:US
Practice Address - Phone:973-287-6086
Practice Address - Fax:862-210-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory