1134191927 NPI number — AMERIPATH NEW YORK LLC

Table of content: (NPI 1134191927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134191927 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:
Provider Other Organization Name Type Code:
6
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:
1134191927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2022
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:
145 E 32ND ST
Provider Second Line Business Practice Location Address:
10TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-6055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-889-6225
Provider Business Practice Location Address Fax Number:
212-889-8268
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOLAN
Authorized Official First Name:
KRISTIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
866-697-8378

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  33D0961556 , 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: L28661 . This is a "BCBS NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02083952 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2966447 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9011706 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001435 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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