Provider Demographics
NPI:1558170977
Name:INNOTERIX LLC
Entity type:Organization
Organization Name:INNOTERIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITILENES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-723-1098
Mailing Address - Street 1:2 LONE SPRUCE TRL
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-2308
Mailing Address - Country:US
Mailing Address - Phone:908-723-1098
Mailing Address - Fax:
Practice Address - Street 1:900 WIND RIVER LN STE 106
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1924
Practice Address - Country:US
Practice Address - Phone:908-723-1098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory