NPIMap

Organization Active NPI

Illume Fertility, PLLC

  • Clinical Medical Laboratory
  • Norwalk, CT
National Provider Identifier
1407031800
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
ILLUME FERTILITY, PLLC
Practice address
761 Main Ave
Suite 200
Norwalk, CT 06851-1080
Phone
(203) 750-7400
NPI assigned
Jan 3, 2008
Last updated
Mar 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Authorized official

Name
Robin Mangieri
Title
Ceo
Phone
(203) 750-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

761 Main Ave
Suite 200
Norwalk, CT 06851-1080

Mailing address

761 Main Ave
Suite 200
Norwalk, CT 06851-1080
Phone (203) 750-7400

Other names 1

  • Laboratory at Reproductive Medicine Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0973463Illume Fertility761 Main Ave, Ste 200, Norwalk, CT 06851ComplianceDec 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ambulatory Surgical Center at Reproductive Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1407031800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 MAIN AVE",
            "address_2": "SUITE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511080",
            "telephone_number": "203-750-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 MAIN AVE",
            "address_2": "SUITE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511080",
            "telephone_number": "203-750-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUME FERTILITY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A",
        "authorized_official_last_name": "MANGIERI",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-750-7400"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laboratory at Reproductive Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Laboratory at Reproductive Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Norwalk, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.