1922075886 NPI number — MORRISTOWN PATHOLOGY ASSOCIATES, PA

Table of content: (NPI 1922075886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922075886 NPI number — MORRISTOWN PATHOLOGY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRISTOWN PATHOLOGY ASSOCIATES, 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:
1922075886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKETTSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07840-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-6136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-971-5612
Provider Business Practice Location Address Fax Number:
973-290-7370
Provider Enumeration Date:
02/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAGIDSON
Authorized Official First Name:
JORY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-971-5612

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 25MF00056400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3242501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".