1144590449 NPI number — COURTAGEN LIFE SCIENCES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144590449 NPI number — COURTAGEN LIFE SCIENCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COURTAGEN LIFE SCIENCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COURTAGEN DIAGNOSTICS LABORATORY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144590449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CABOT RD
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-395-7608
Provider Business Mailing Address Fax Number:
617-249-0394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 CABOT RD
Provider Second Line Business Practice Location Address:
SUITE 2000
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-395-7608
Provider Business Practice Location Address Fax Number:
617-249-0394
Provider Enumeration Date:
01/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCKERNAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
617-892-7179

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  APPLIED FOR , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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