Provider Demographics
NPI:1568641512
Name:REPROGENETICS
Entity Type:Organization
Organization Name:REPROGENETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-601-9808
Mailing Address - Street 1:3 REGENT ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-436-5000
Mailing Address - Fax:973-992-1423
Practice Address - Street 1:3 REGENT ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1668
Practice Address - Country:US
Practice Address - Phone:973-436-5017
Practice Address - Fax:973-992-1423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPERGENOMICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-26
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D1054821291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory