Provider Demographics
NPI:1013418300
Name:NEXGEN BIOLOGICS LLC
Entity Type:Organization
Organization Name:NEXGEN BIOLOGICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOTLYARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-403-5673
Mailing Address - Street 1:164 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2756
Mailing Address - Country:US
Mailing Address - Phone:201-403-5673
Mailing Address - Fax:
Practice Address - Street 1:164 ENGLE ST
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2756
Practice Address - Country:US
Practice Address - Phone:201-403-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)