Basic Information
| Provider Information | |||||||||
| NPI: | 1205063294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HISTOPATHOLOGY SERVICES LLC | ||||||||
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| OtherOrganizationName: | PATHLINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 E CRESCENT AVE | ||||||||
| Address2: | C/O HISTOPATHOLOGY SERVICES LLC | ||||||||
| City: | RAMSEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074462922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016617280 | ||||||||
| FaxNumber: | 2016617297 | ||||||||
| Practice Location | |||||||||
| Address1: | 156 ROUTE 59 | ||||||||
| Address2: | SUITE B4 | ||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109015005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453694200 | ||||||||
| FaxNumber: | 2016617297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 09/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | NEWMAN | ||||||||
| AuthorizedOfficialFirstName: | SCHUYLER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2016617280 | ||||||||
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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 | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.