=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649388208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW BRITAIN SLEEP LABORATORY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 LAKE ST SUITE 305
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06052-1396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-770-6748
-----------------------------------------------------
Fax | 860-656-7627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE LAKE STREET SUITE 305
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-770-6748
-----------------------------------------------------
Fax | 860-656-7627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MICHAEL J GENOVESI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-770-6748
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------