Provider Demographics
NPI:1164524930
Name:UNIVERSITY PATHOLOGY, P.C.
Entity Type:Organization
Organization Name:UNIVERSITY PATHOLOGY, P.C.
Other - Org Name:BRADHURST LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-693-6268
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:BRADHURST LAB
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-493-2153
Mailing Address - Fax:
Practice Address - Street 1:1 WESTCHESTER PLZ
Practice Address - Street 2:BRADHURST LAB
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1600
Practice Address - Country:US
Practice Address - Phone:914-517-2488
Practice Address - Fax:914-493-2084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PATHOLOGY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-02
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0553291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02241481Medicaid
L84761Medicare PIN