Healthcare Provider Details

I. General information

NPI: 1568641512
Provider Name (Legal Business Name): REPROGENETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 REGENT ST SUITE 301
LIVINGSTON NJ
07039-1668
US

IV. Provider business mailing address

3 REGENT ST SUITE 301
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 973-436-5017
  • Fax: 973-992-1423
Mailing address:
  • Phone: 973-436-5000
  • Fax: 973-992-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number31D1054821
License Number StateNJ

VIII. Authorized Official

Name: ALAN TUCKER
Title or Position: CFO
Credential:
Phone: 203-601-9808