Personalized Genetics LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

39D2109711 Issued in PA

Legal business name

PERSONALIZED GENETICS LLC

Doing business as

Personalized Genomics

Practice address

607 College Ave
Pittsburgh, PA 15232-1700

Phone

(412) 361-6160

NPI assigned

Jun 9, 2016

Last updated

Mar 14, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ravitej B Reddy

Title

Ceo

Phone

(412) 656-4941

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Personalized Genomics Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552521600000",
    "number": "1336598325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 COLLEGE AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152321700",
            "telephone_number": "412-361-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 COLLEGE AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152321700",
            "telephone_number": "412-361-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED GENETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-09",
        "last_updated": "2019-03-14",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "RAVITEJ",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "412-656-4941"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "39D2109711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1032451710001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Personalized Genomics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Personalized Genomics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Clinical Medical Laboratory in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.