1336545508 NPI number — PROMED PATHOLOGY, LLC

Table of content: (NPI 1336545508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336545508 NPI number — PROMED PATHOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMED PATHOLOGY, 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:
1336545508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 743
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:
07840-0743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-979-0200
Provider Business Mailing Address Fax Number:
908-979-9934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 WESCOTT DRIVE
Provider Second Line Business Practice Location Address:
HUNTERDON MEDICAL CENTER PATHOLOGY
Provider Business Practice Location Address City Name:
FLEMINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08822-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-788-6407
Provider Business Practice Location Address Fax Number:
908-237-2334
Provider Enumeration Date:
11/14/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAGIDSON
Authorized Official First Name:
JORY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MANAGING PARTNER
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" .

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