Provider Demographics
NPI:1134102221
Name:WAYNE PATHOLOGISTS PA
Entity Type:Organization
Organization Name:WAYNE PATHOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ESPINAL-MARIOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-942-6900
Mailing Address - Street 1:PO BOX 144333
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-4333
Mailing Address - Country:US
Mailing Address - Phone:407-422-9831
Mailing Address - Fax:407-648-2065
Practice Address - Street 1:224 HAMBURG TPKE
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2111
Practice Address - Country:US
Practice Address - Phone:973-942-6900
Practice Address - Fax:973-389-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE1709OtherRAILROAD MEDICARE
NJ3368904Medicaid
CE1709OtherRAILROAD MEDICARE