Sophora Diagnostic Lab Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOPHORA DIAGNOSTIC LAB INC

Practice address

79-18 164 St
Jamaica, NY 11432

Phone

(718) 969-2884

Fax

(718) 969-2576

NPI assigned

Jan 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mikhail I KantiusNPI 1235100363

Title

President Owner

Phone

(718) 969-2884

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mikhail I Kantius, MD

  • Dermatopathology Physician
  • Jamaica, NY
  • NPI 1235100363
  NPD Authorized official

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1669451563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740048",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "11374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79-18 164 ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "11432",
            "telephone_number": "718-969-2884",
            "fax_number": "718-969-2576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOPHORA DIAGNOSTIC LAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "KANTIUS",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "718-969-2884",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xiaoling Song, M.D.
• Larry A Sonna, M.D.
• Allison Sonnenblick, OTR
• Fareeda Soodoo
• Suraj I Sookhu
• Marie C Soreng
• Soriano Family Services LLC
• Carmen Alicia Soriano, MS
• Chasity Soriano
• Luisa Sosa Vasquez

• Clinical Medical Laboratory in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Clinical Medical Laboratory in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.