1215692934 NPI number — PATHOLOGY CONSULTANTS OF SOUTH BROWARD, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215692934 NPI number — PATHOLOGY CONSULTANTS OF SOUTH BROWARD, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOLOGY CONSULTANTS OF SOUTH BROWARD, LLP
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:
1215692934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9581 PREMIER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-276-1864
Provider Business Mailing Address Fax Number:
954-967-7630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-987-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MALEK
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-276-1857

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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