Provider Demographics
NPI:1215259718
Name:COAGTECH LLC
Entity type:Organization
Organization Name:COAGTECH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTALENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-530-8885
Mailing Address - Street 1:97 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1232
Mailing Address - Country:US
Mailing Address - Phone:203-530-8885
Mailing Address - Fax:203-777-4906
Practice Address - Street 1:97 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1232
Practice Address - Country:US
Practice Address - Phone:203-530-8885
Practice Address - Fax:203-777-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory