Basic Information
Provider Information | |||||||||
NPI: | 1922089291 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW ROCHELLE PATHOLOGY SRVS PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16 GUION PL | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108015503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146371670 | ||||||||
FaxNumber: | 9146322927 | ||||||||
Practice Location | |||||||||
Address1: | 16 GUION PL | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108015503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146371670 | ||||||||
FaxNumber: | 9146322927 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2005 | ||||||||
LastUpdateDate: | 01/04/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZAMUROVIC | ||||||||
AuthorizedOfficialFirstName: | DRAGOSLAVA | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR LABORATORY AND PATHOLOGY | ||||||||
AuthorizedOfficialTelephone: | 9146371670 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 33DO653713 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.