Organization Active NPI

Cytogenx Corp

  • Clinical Medical Laboratory
  • Stony Brook, NY
National Provider Identifier
1740353853
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
7948 Issued in NY
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

Updated by the provider on Oct 15, 2014

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

Authorized official

Name
Dr. Teresa Dunn, PHDNPI 1851539399
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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
008025569MedicaidCT
0249360MedicaidNJ
02211796MedicaidNY
001891800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100310000262 NY Part B Supplier - Independent Clinical Laboratory 3274678644 Practice locations: Stony Brook, NY

National Provider Directory

National Provider Directory

Locations

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.

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.

Verify at the official NPI Registry.