Provider Demographics
NPI:1891864997
Name:CONNECTIVE TISSUE GENE TESTS, LLC
Entity Type:Organization
Organization Name:CONNECTIVE TISSUE GENE TESTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALA-KOKKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:484-244-2900
Mailing Address - Street 1:6575 SNOWDRIFT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9353
Mailing Address - Country:US
Mailing Address - Phone:484-244-2900
Mailing Address - Fax:484-244-2904
Practice Address - Street 1:6575SNOWDRIFT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:484-244-2900
Practice Address - Fax:484-244-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063053L291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory