Provider Demographics
NPI:1801084645
Name:THE EMBRYOLOGY NETWORK
Entity type:Organization
Organization Name:THE EMBRYOLOGY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KELLOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-434-9006
Mailing Address - Street 1:462 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3601
Mailing Address - Country:US
Mailing Address - Phone:518-434-9006
Mailing Address - Fax:518-471-3686
Practice Address - Street 1:600 NORTHERN BLVD.
Practice Address - Street 2:ALBANY MEMORIAL HOSPITAL
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:518-471-3276
Practice Address - Fax:518-471-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYGA121291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory