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General NPI Number Information
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NPI Number | 1801084645
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Entity Type | Organization
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Legal Business Name | THE EMBRYOLOGY NETWORK
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 600 NORTHERN BLVD. ALBANY MEMORIAL HOSPITAL
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City | ALBANY
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State | NY
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Zip | 12204
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Country | US
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Telephone | 518-471-3276
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Fax | 518-471-3686
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Provider Business Mailing Address
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Address Line | 462 MADISON AVE
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City | ALBANY
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State | NY
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Zip | 12208-3601
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Country | US
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Telephone | 518-434-9006
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Fax | 518-471-3686
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. THERESA ANN KELLOM
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Credential | PH.D.
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Telephone | 518-434-9006
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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 | GA121
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License Number State | NY
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