Prophase Diagnostics Ny, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PROPHASE DIAGNOSTICS NY, INC

Practice address

711 Stewart Ave
Ste 200
Garden City, NY 11530-4719

Phone

(516) 464-6121

NPI assigned

Jul 22, 2021

Last updated

Nov 16, 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

Prophase Labs, Inc

Title

Owner

Phone

(516) 464-6121

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1942873484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 STEWART AVE STE 200",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304734",
            "telephone_number": "516-464-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 STEWART AVE",
            "address_2": "STE 200",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304719",
            "telephone_number": "516-464-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROPHASE DIAGNOSTICS NY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2023-11-16",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "LABS, INC",
        "authorized_official_first_name": "PROPHASE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-464-6121"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.