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General NPI Number Information
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NPI Number | 1891864997
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Entity Type | Organization
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Legal Business Name | CONNECTIVE TISSUE GENE TESTS, LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 6575SNOWDRIFT RD SUITE 106
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City | ALLENTOWN
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State | PA
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Zip | 18106
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Country | US
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Telephone | 484-244-2900
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Fax | 484-244-2904
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Provider Business Mailing Address
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Address Line | 6575 SNOWDRIFT RD SUITE 106
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City | ALLENTOWN
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State | PA
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Zip | 18106-9353
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Country | US
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Telephone | 484-244-2900
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Fax | 484-244-2904
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEENA ALA-KOKKO
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Credential | M.D., PH.D
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Telephone | 484-244-2900
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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 | MD063053L
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License Number State | PA
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