Basic Information
| Provider Information | |||||||||
| NPI: | 1316939820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONEIDA PATHOLOGY ASSOCIATES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1849 | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042411849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077842554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 321 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134212611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153612020 | ||||||||
| FaxNumber: | 3153612221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRABER | ||||||||
| AuthorizedOfficialFirstName: | BELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3153612020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 192964 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 03460280 | 05 | NY | MEDICAID |