1881768448 NPI number — RIDGEWOOD PATHOLOGY GROUP,PA

Table of content: (NPI 1881768448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881768448 NPI number — RIDGEWOOD PATHOLOGY GROUP,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGEWOOD PATHOLOGY GROUP,PA
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:
Provider Other Organization Name Type Code:
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:
1881768448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
570 UPPER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07450-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-444-0451
Provider Business Mailing Address Fax Number:
201-493-9534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 N VAN DIEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-447-8242
Provider Business Practice Location Address Fax Number:
201-251-3314
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REILLY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-447-8242

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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