Provider Demographics
NPI:1235462904
Name:ADVANCED PATHOLOGY OF PALM BEACH COUNTY, PA
Entity Type:Organization
Organization Name:ADVANCED PATHOLOGY OF PALM BEACH COUNTY, PA
Other - Org Name:ADVANCED PATHOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-273-2340
Mailing Address - Street 1:5065 STATE ROAD 7
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4615
Mailing Address - Country:US
Mailing Address - Phone:561-273-2340
Mailing Address - Fax:
Practice Address - Street 1:5065 STATE ROAD 7
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-4615
Practice Address - Country:US
Practice Address - Phone:561-273-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory