Provider Demographics
NPI:1558159202
Name:NEW GENE LABS LLC
Entity type:Organization
Organization Name:NEW GENE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VEJITH CHENCHU GOWDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-310-9746
Mailing Address - Street 1:6955 NORTH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6955 NORTH AVE STE 102
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1016
Practice Address - Country:US
Practice Address - Phone:872-310-9746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory