Provider Demographics
NPI:1306439138
Name:GENOPHYLL ENTERPRISES LLC
Entity type:Organization
Organization Name:GENOPHYLL ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADITI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTHRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-945-0190
Mailing Address - Street 1:1 DEERPARK DR STE L1
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DEERPARK DR STE L1
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-1920
Practice Address - Country:US
Practice Address - Phone:732-945-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory