Provider Demographics
NPI:1396849022
Name:PATHOLOGY OUTREACH, PC
Entity Type:Organization
Organization Name:PATHOLOGY OUTREACH, PC
Other - Org Name:CLEARPATH DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOZEFCYZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-234-3300
Mailing Address - Street 1:600 E GENESEE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3108
Mailing Address - Country:US
Mailing Address - Phone:315-234-3300
Mailing Address - Fax:
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3108
Practice Address - Country:US
Practice Address - Phone:315-234-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1044Medicare ID - Type Unspecified
NYCC9400Medicare ID - Type Unspecified