Provider Demographics
NPI:1649388208
Name:NEW BRITAIN SLEEP LABORATORY, LLC
Entity Type:Organization
Organization Name:NEW BRITAIN SLEEP LABORATORY, LLC
Other - Org Name:CONNECTICUT SLEEP LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GENOVESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-770-6748
Mailing Address - Street 1:ONE LAKE STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052
Mailing Address - Country:US
Mailing Address - Phone:860-770-6748
Mailing Address - Fax:860-656-7627
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-770-6748
Practice Address - Fax:860-656-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT40GOtherANTHEM
CT4249919Medicaid
CT9574485OtherCIGNA
CTIV1003OtherHEALTHNET
CT662355OtherCONNECTICARE
CT7416696OtherAETNA