Advantage Diagnostics Clinical Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ADVANTAGE DIAGNOSTICS CLINICAL LABORATORY LLC

Practice address

B3 Cornwall Dr
East Brunswick, NJ 08816-3361

Phone

(732) 965-7870

Fax

(732) 856-5220

NPI assigned

Jun 17, 2022

Last updated

Sep 25, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Polina Genkin

Title

Owner

Phone

(973) 632-2681

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1497486880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076020429",
            "telephone_number": "732-965-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "B3 CORNWALL DR",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163361",
            "telephone_number": "732-965-7870",
            "fax_number": "732-856-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DIAGNOSTICS CLINICAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-17",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "GENKIN",
        "authorized_official_first_name": "POLINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-632-2681"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in East Brunswick, NJ
• Providers in East Brunswick, NJ by specialty
• Clinical Medical Laboratory in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.