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General NPI Number Information
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NPI Number | 1801810452
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Entity Type | Organization
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Legal Business Name | IMUGEN INC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 315 NORWOOD PARK S
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City | NORWOOD
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State | MA
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Zip | 02062-4681
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Country | US
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Telephone | 800-246-8436
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Fax | 781-255-9923
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Provider Business Mailing Address
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Address Line | 315 NORWOOD PARK S
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City | NORWOOD
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State | MA
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Zip | 02062-4681
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Country | US
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Telephone | 800-246-8436
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Fax | 781-255-9923
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTOR P BERARDI
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Credential |
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Telephone | 800-246-8436
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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 | 2349
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License Number State | MA
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