Provider Demographics
NPI:1073236782
Name:ISLAND PATHOLOGY DIAGNOSTICS
Entity Type:Organization
Organization Name:ISLAND PATHOLOGY DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAH
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:GIASHUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-376-5739
Mailing Address - Street 1:77A POWERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2027
Mailing Address - Country:US
Mailing Address - Phone:917-376-5739
Mailing Address - Fax:
Practice Address - Street 1:77A POWERHOUSE RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2027
Practice Address - Country:US
Practice Address - Phone:917-376-5739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty