Provider Demographics
NPI:1376006932
Name:GEMELLI BIOTECH CORP.
Entity Type:Organization
Organization Name:GEMELLI BIOTECH CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF MARKET ACCESS
Authorized Official - Prefix:
Authorized Official - First Name:FAB
Authorized Official - Middle Name:
Authorized Official - Last Name:WILFONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-222-4991
Mailing Address - Street 1:2020 PROGRESS CT STE 100-101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2767
Mailing Address - Country:US
Mailing Address - Phone:855-888-1230
Mailing Address - Fax:818-301-3222
Practice Address - Street 1:2450 W BROADWAY RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1072
Practice Address - Country:US
Practice Address - Phone:855-888-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory