1528078813 NPI number — SURGICAL PATHOLOGY ASSOCIATES, LLC

Table of content: (NPI 1528078813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528078813 NPI number — SURGICAL PATHOLOGY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL PATHOLOGY ASSOCIATES, 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:
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:
1528078813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 GEORGETOWN WRIGHTSTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WRIGHTSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08562-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-723-0070
Provider Business Mailing Address Fax Number:
609-723-0073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 GEORGETOWN WRIGHTSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WRIGHTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08562-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-723-0070
Provider Business Practice Location Address Fax Number:
609-723-0073
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGINNIS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-723-0070

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA00747300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 25MA00747300 , 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)

  • Identifier: 2359692000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DD1085 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0051543 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5001537 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 100745580A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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