1164524930 NPI number — UNIVERSITY PATHOLOGY, P.C.

Table of content: RICHARD SCOTT CAMPBELL M.D. (NPI 1497764393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164524930 NPI number — UNIVERSITY PATHOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PATHOLOGY, P.C.
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:
1164524930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BRADHURST AVE
Provider Second Line Business Mailing Address:
BRADHURST LAB
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10532-2140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-493-2153
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WESTCHESTER PLZ
Provider Second Line Business Practice Location Address:
BRADHURST LAB
Provider Business Practice Location Address City Name:
ELMSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10523-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-517-2488
Provider Business Practice Location Address Fax Number:
914-493-2084
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MELAMED
Authorized Official First Name:
MYRON
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-693-6268

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0553 , 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: 02241481 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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