Provider Demographics
NPI:1316263924
Name:CENTROMERE DIAGNOSTIC, LLC
Entity type:Organization
Organization Name:CENTROMERE DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SHERBINY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-289-8765
Mailing Address - Street 1:230 W PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1267
Mailing Address - Country:US
Mailing Address - Phone:201-289-8766
Mailing Address - Fax:201-289-8764
Practice Address - Street 1:230 W PASSAIC ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1267
Practice Address - Country:US
Practice Address - Phone:201-289-8766
Practice Address - Fax:201-289-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00017464291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory