Provider Demographics
NPI:1427273598
Name:CDX DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:CDX DIAGNOSTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-368-7448
Mailing Address - Street 1:2 EXECUTIVE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-8217
Mailing Address - Country:US
Mailing Address - Phone:845-369-7096
Mailing Address - Fax:845-369-1682
Practice Address - Street 1:2 EXECUTIVE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-8217
Practice Address - Country:US
Practice Address - Phone:845-369-7096
Practice Address - Fax:845-369-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133142-1291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLZZZ71Medicare PIN