Enzo Clinical Labs, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ENZO CLINICAL LABS, INC.

Practice address

4 Corporate Dr Ste 283
Shelton, CT 06484-6211

Phone

(203) 513-8587

NPI assigned

Nov 19, 2019

Last updated

Mar 9, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

ENZO BIOCHEM INC.As reported in NPPES

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

Authorized official

Name

Ann Marie Wagner

Title

Revenue Cycle Director

Phone

(631) 715-3266

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Krenitsky, M.D.

  • Adult Medicine Physician
  • Farmingdale, NY
  • NPI 1013148618
  NPD (past)
• Shahrokh Momtahen, MD

  • Clinical Medical Laboratory
  • Farmingdale, NY
  • NPI 1104959659
  NPD (past)
• Dieter M Schapfel, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Bay Shore, NY
  • NPI 1912967175
  NPD (past)

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1568008118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 EXECUTIVE BLVD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117354710",
            "telephone_number": "631-755-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CORPORATE DR STE 283",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846211",
            "telephone_number": "203-513-8587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Executive Blvd",
            "address_purpose": "LOCATION",
            "city": "Farmingdale",
            "state": "NY",
            "postal_code": "117354710",
            "country_code": "US",
            "telephone_number": "631-755-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ENZO CLINICAL LABS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENZO BIOCHEM INC.",
        "enumeration_date": "2019-11-19",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "631-715-3266"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Shelton, CT
• Providers in Shelton, CT by specialty
• Clinical Medical Laboratory in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.