Provider Demographics
NPI:1083781090
Name:LIVINGSTON PATHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LIVINGSTON PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAPTIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-322-5763
Mailing Address - Street 1:PO BOX 66689
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-6689
Mailing Address - Country:US
Mailing Address - Phone:866-689-8862
Mailing Address - Fax:207-347-7401
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-5763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01222262Medicaid
NJ108821Medicare PIN