Provider Demographics
NPI:1932381159
Name:IKONISYS INC.
Entity Type:Organization
Organization Name:IKONISYS INC.
Other - Org Name:IKONISYS CLINICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-776-0791
Mailing Address - Street 1:5 SCIENCE PARK
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1966
Mailing Address - Country:US
Mailing Address - Phone:203-776-0791
Mailing Address - Fax:203-776-0795
Practice Address - Street 1:5 SCIENCE PARK
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1966
Practice Address - Country:US
Practice Address - Phone:203-776-0791
Practice Address - Fax:203-776-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory