Sophora Diagnostic Lab INC
Clinical Medical Laboratory in Jamaica, NY. Organization (NPI-2).
NPI number1669451563
StatusActive
Last updated in NPPESAug 22, 2007
Details
- NPI
- 1669451563
- Entity type
- Organization (NPI-2)
- Legal business name
- Sophora Diagnostic Lab INC
- Organization subpart
- No
- Enumeration date
- Jan 10, 2006
- Last updated
- Aug 22, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291U00000X | Clinical Medical Laboratory | – | – | Yes |
Practice location
79-18 164 StJamaica, NY 11432
Phone 718-969-2884 · Fax 718-969-2576
Mailing address
Po Box 740048Rego Park, NY 11374
Authorized official
Mikhail I Kantius
President Owner
7189692884
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