Provider Demographics
NPI:1447437355
Name:NEOGENOMICS LABORATORIES INC
Entity type:Organization
Organization Name:NEOGENOMICS LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-776-5907
Mailing Address - Street 1:PO BOX 865365
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4110
Mailing Address - Country:US
Mailing Address - Phone:866-776-5907
Mailing Address - Fax:888-443-4153
Practice Address - Street 1:31 COLUMBIA
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656
Practice Address - Country:US
Practice Address - Phone:866-776-5907
Practice Address - Fax:888-443-4153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOGENOMICS LABORATORIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00011815291U00000X
CA291U00000X
CA00350209291U00000X
CACLF00350209291U00000X
CACLF00351391291U00000X
CACLF00350153291U00000X
CACLF00351390291U00000X
CACLF00350178291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1021650OtherCLIA
CA05D2129568OtherCLIA
CA05D2129017OtherCLIA
CA05D2129566OtherCLIA