1194797993 NPI number — AMERIPATH NEW YORK LLC

Table of content: (NPI 1194797993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194797993 NPI number — AMERIPATH NEW YORK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIPATH NEW YORK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERIPATH NORTHEAST
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194797993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-932-8029
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GREENWICH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06484-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-436-9631
Provider Business Practice Location Address Fax Number:
203-447-8666
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
610-550-3000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  07D1035411 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004250130 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200279840A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100771649003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001262 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176325201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810005215 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015532634A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22339752 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412163500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00237 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0093254 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2643769 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com