Provider Demographics
NPI:1972979573
Name:GENE PRAXIS LLC
Entity type:Organization
Organization Name:GENE PRAXIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIPOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-208-0594
Mailing Address - Street 1:36 E INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-6533
Mailing Address - Country:US
Mailing Address - Phone:203-208-0594
Mailing Address - Fax:
Practice Address - Street 1:36 E INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-6533
Practice Address - Country:US
Practice Address - Phone:203-208-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory