Basic Information
| Provider Information | |||||||||
| NPI: | 1093744633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RANCOCAS ZURBRUGG PATHOLOGY ASSOC INC | ||||||||
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| OtherOrganizationName: | INC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5075 | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080345075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566168100 | ||||||||
| FaxNumber: | 8566161919 | ||||||||
| Practice Location | |||||||||
| Address1: | 218A SUNSET ROAD | ||||||||
| Address2: | |||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566168600 | ||||||||
| FaxNumber: | 8566161919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHOI | ||||||||
| AuthorizedOfficialFirstName: | HONG | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR OF CLINICAL LAB | ||||||||
| AuthorizedOfficialTelephone: | 8566168100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4623207 | 05 | NJ | MEDICAID |