Provider Demographics
NPI:1235121575
Name:ST. JOSEPH'S PATHOLOGY, PC
Entity Type:Organization
Organization Name:ST. JOSEPH'S PATHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PATHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:315-448-5416
Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-434-9309
Mailing Address - Fax:315-454-0136
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154235207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty