1639166549 NPI number — DERMATOPATHOLOGY CONSULTANTS, LLC

Table of content: (NPI 1639166549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639166549 NPI number — DERMATOPATHOLOGY CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOPATHOLOGY CONSULTANTS, 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:
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NPI Number Information

NPI Number:
1639166549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 STOCKTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADOWBROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-886-4272
Provider Business Mailing Address Fax Number:
856-310-1081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 WHITE HORSE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADDON HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08035-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-310-1080
Provider Business Practice Location Address Fax Number:
856-310-1081
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
856-310-1080

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  25MA07850300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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