Provider Demographics
NPI:1265097745
Name:COSMOSID NGS LABORATORY SERVICES
Entity type:Organization
Organization Name:COSMOSID NGS LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DADLANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-995-9879
Mailing Address - Street 1:1600 E GUDE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1496
Mailing Address - Country:US
Mailing Address - Phone:703-995-9879
Mailing Address - Fax:
Practice Address - Street 1:1600 E GUDE DR STE 210
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1496
Practice Address - Country:US
Practice Address - Phone:703-995-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory