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General NPI Number Information
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NPI Number | 1336325497
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Entity Type | Organization
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Legal Business Name | GENOMAS, INC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 67 JEFFERSON ST
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City | HARTFORD
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State | CT
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Zip | 06106-2504
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Country | US
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Telephone | 860-545-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 67 JEFFERSON ST
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City | HARTFORD
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State | CT
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Zip | 06106-2504
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Country | US
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Telephone | 860-545-4574
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. GUALBERTO RUANO
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Credential | M.D., PH.D.
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Telephone | 860-545-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CL-0644
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License Number State | CT
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