1275776452 NPI number — BIOPSY DIAGNOSTICS, PC

Table of content: (NPI 1275776452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275776452 NPI number — BIOPSY DIAGNOSTICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOPSY DIAGNOSTICS, PC
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:
BIOPSY DIAGNOSTICS-NY
Provider Other Organization Name Type Code:
3
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:
1275776452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 BROWNS COVE RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29936-8182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-379-2939
Provider Business Mailing Address Fax Number:
843-379-2949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 SOUTHLAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOBBS FERRY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10522-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-518-1625
Provider Business Practice Location Address Fax Number:
914-478-3638
Provider Enumeration Date:
04/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
843-379-2939

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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