Provider Demographics
NPI:1891978219
Name:THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES, PC
Entity Type:Organization
Organization Name:THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES, PC
Other - Org Name:LABORATORY AT REPRODUCTIVE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, MANAGED CARE CONTRACTING, IVS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-3428
Mailing Address - Street 1:2 BATTERSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2568
Mailing Address - Country:US
Mailing Address - Phone:860-679-4580
Mailing Address - Fax:860-679-3639
Practice Address - Street 1:2 BATTERSON PARK RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2568
Practice Address - Country:US
Practice Address - Phone:860-679-4580
Practice Address - Fax:860-679-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07D0709026291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
07D0709026OtherCLIA