Provider Demographics
NPI:1205857984
Name:SOUND SHORE MEDICAL CENTER DEPARTMENT OF LABORATORIES
Entity Type:Organization
Organization Name:SOUND SHORE MEDICAL CENTER DEPARTMENT OF LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LABORATORY AT SSHC
Authorized Official - Prefix:
Authorized Official - First Name:DRAGOSLAVA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZAMUROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-637-1670
Mailing Address - Street 1:16 GUION PLACE
Mailing Address - Street 2:DEPARTMENT OF LABORATORIES
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10802
Mailing Address - Country:US
Mailing Address - Phone:914-632-5000
Mailing Address - Fax:914-632-2927
Practice Address - Street 1:16 GUION PLACE
Practice Address - Street 2:DEPARTMENT OF LABORATORIES
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10802
Practice Address - Country:US
Practice Address - Phone:914-632-5000
Practice Address - Fax:914-632-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00274126Medicaid
NY330184Medicare ID - Type Unspecified