Basic Information
| Provider Information | |||||||||
| NPI: | 1265417273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFILIATED PATHOLOGY SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
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| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121100909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187854609 | ||||||||
| FaxNumber: | 5187861293 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 NEW SCOTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122083412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182623738 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5182623738 | ||||||||
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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 | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.