Provider Demographics
NPI:1366960031
Name:ENDO FERTILILTY LAB INC
Entity type:Organization
Organization Name:ENDO FERTILILTY LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MTASCP
Authorized Official - Phone:917-405-4444
Mailing Address - Street 1:7804 73RD PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7426
Mailing Address - Country:US
Mailing Address - Phone:917-405-4444
Mailing Address - Fax:
Practice Address - Street 1:332 EAST 30TH ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:917-405-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory