Provider Demographics
NPI:1780311746
Name:IMMUNOVIA, INC.
Entity type:Organization
Organization Name:IMMUNOVIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCHERDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-403-9880
Mailing Address - Street 1:26 FOREST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3068
Mailing Address - Country:US
Mailing Address - Phone:833-593-9522
Mailing Address - Fax:
Practice Address - Street 1:26 FOREST ST STE 110
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3068
Practice Address - Country:US
Practice Address - Phone:833-593-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory