Basic Information
| Provider Information | |||||||||
| NPI: | 1538821327 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATHLINK OF NEW JERSEY | ||||||||
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| OtherOrganizationName: | PATHLINK OF NEW JERSEY LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 W GILBERT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120060 | ||||||||
| FaxNumber: | 7322120061 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 W GILBERT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134907206 | ||||||||
| FaxNumber: | 8138866655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2021 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | BATTAGLIA | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7322120060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | 10/08/2021 | ||||||||
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.