Basic Information
| Provider Information | |||||||||
| NPI: | 1144212747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY AND LABORATORY CONSULTANTS OF LONG ISLAND, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6390 FLY RD | ||||||||
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| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130579349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774018406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 MONTAUK HWY | ||||||||
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| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313763000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | ENGELLENNER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6313763990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 182397 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.