Healthcare Provider Details

I. General information

NPI: 1891978219
Provider Name (Legal Business Name): THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 01/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BATTERSON PARK RD
FARMINGTON CT
06032-2568
US

IV. Provider business mailing address

2 BATTERSON PARK RD
FARMINGTON CT
06032-2568
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4580
  • Fax: 860-679-3639
Mailing address:
  • Phone: 860-679-4580
  • Fax: 860-679-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number07D0709026
License Number StateCT

VIII. Authorized Official

Name: MS. DIANE RAVECH
Title or Position: VP, MANAGED CARE CONTRACTING, IVS
Credential:
Phone: 860-678-3428