Provider Demographics
NPI:1871920645
Name:MEDLABS GENETICS
Entity type:Organization
Organization Name:MEDLABS GENETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITILENES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-723-1098
Mailing Address - Street 1:85 HORSEHILL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 HORSEHILL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2003
Practice Address - Country:US
Practice Address - Phone:973-419-6828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0007308291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory