Provider Demographics
NPI:1083212351
Name:TELOMERE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:TELOMERE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-519-6626
Mailing Address - Street 1:27 DRYDOCK AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2688 MIDDLEFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3483
Practice Address - Country:US
Practice Address - Phone:650-369-0699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORIG3N, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory