Provider Demographics
NPI:1821153156
Name:CENTER FOR HUMAN GENETICS, INC
Entity Type:Organization
Organization Name:CENTER FOR HUMAN GENETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILUNSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-492-7083
Mailing Address - Street 1:840 MEMORIAL DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-492-7083
Mailing Address - Fax:617-492-7092
Practice Address - Street 1:840 MEMORIAL DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-492-7083
Practice Address - Fax:617-492-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2424291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0805181Medicaid
NY01336272Medicaid
NH30006321Medicaid
MA0805181Medicaid