Active NPI
Cytogenx Corp
- Clinical Medical Laboratory
- Stony Brook, NY
National Provider Identifier
1740353853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- 7948
- Legal business name
- CYTOGENX CORP
- Practice address
- 1212 Route 25a
Suite # 1C
Stony Brook, NY 11790-1919 - Phone
- (631) 751-0212
- Fax
- (631) 751-0944
- NPI assigned
- Nov 16, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Teresa Dunn, PHD
- Title
- Ceo
- Phone
- (631) 751-0212
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 7948 | NY | Primary |
| Clinical Medical Laboratory | 291U00000X | 800026179 | FL |
Addresses
Primary practice location
1212 Route 25a
Suite # 1C
Stony Brook, NY 11790-1919
Mailing address
PO Box 339
Stony Brook, NY 11790-1919
Phone (631) 751-0212
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008025569 | Medicaid | CT | |
| 0249360 | Medicaid | NJ | |
| 02211796 | Medicaid | NY | |
| 001891800 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100310000262 | NY | Part B Supplier - Independent Clinical Laboratory | 3274678644 | Practice locations: Stony Brook, NY |
National Provider Directory
National Provider DirectoryLocations
1212 Route 25A
Ste 1C
Stony Brook, NY 11790
Phone (631) 751-0212
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ph.D. Medical Genetics
- Stony Brook, NY
- NPI 1851539399
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1413331200000",
"number": "1740353853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 339",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117901919",
"telephone_number": "631-751-0212",
"fax_number": "631-751-0944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 ROUTE 25A",
"address_2": "SUITE # 1C",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117901919",
"telephone_number": "631-751-0212",
"fax_number": "631-751-0944"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CYTOGENX CORP",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-16",
"last_updated": "2014-10-15",
"status": "A",
"authorized_official_last_name": "DUNN",
"authorized_official_first_name": "TERESA",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "631-751-0212",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "NY",
"license": "7948",
"primary": true
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "FL",
"license": "800026179",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008025569",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0249360",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02211796",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001891800",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.