Provider Demographics
NPI:1275588576
Name:ADVANCED PATHOLOGY LABORATORY LLC
Entity Type:Organization
Organization Name:ADVANCED PATHOLOGY LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-646-7000
Mailing Address - Street 1:334 W OAKCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1716
Mailing Address - Country:US
Mailing Address - Phone:609-646-7000
Mailing Address - Fax:609-646-7140
Practice Address - Street 1:334 W OAKCREST AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1716
Practice Address - Country:US
Practice Address - Phone:609-646-7000
Practice Address - Fax:609-646-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00003933291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
102219Medicare PIN