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General NPI Number Information
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NPI Number | 1336598325
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Entity Type | Organization
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Legal Business Name | PERSONALIZED GENETICS LLC
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 607 COLLEGE AVE
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City | PITTSBURGH
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State | PA
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Zip | 15232-1700
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Country | US
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Telephone | 412-361-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 607 COLLEGE AVE
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City | PITTSBURGH
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State | PA
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Zip | 15232-1700
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Country | US
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Telephone | 412-361-6160
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAVITEJ B REDDY
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Credential |
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Telephone | 412-656-4941
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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 | 39D2109711
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License Number State | PA
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