Healthcare Provider Details

I. General information

NPI: 1972777308
Provider Name (Legal Business Name): LAILA O MNAYER M.S, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 PATRICIA M GENOVA DR
NEWINGTON CT
06111-1543
US

IV. Provider business mailing address

129 PATRICIA M GENOVA DR
NEWINGTON CT
06111-1543
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-3589
  • Fax: 860-696-8124
Mailing address:
  • Phone: 860-545-3589
  • Fax: 860-696-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: