Provider Demographics
NPI:1124097829
Name:HARTFORD HEALTHCARE LABORATORIES
Entity type:Organization
Organization Name:HARTFORD HEALTHCARE LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-696-8227
Mailing Address - Street 1:129 PATRICIA M GENOVA DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1543
Mailing Address - Country:US
Mailing Address - Phone:860-696-8010
Mailing Address - Fax:860-665-1979
Practice Address - Street 1:129 PATRICIA M GENOVA DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1543
Practice Address - Country:US
Practice Address - Phone:860-696-8010
Practice Address - Fax:860-665-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL-0385291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004200713Medicaid
CT690000231Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CT690000231Medicare PIN