Provider Demographics
NPI:1407885056
Name:REGIONAL PATHOLOGISTS PC
Entity Type:Organization
Organization Name:REGIONAL PATHOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PATHOLOGY LAB
Authorized Official - Prefix:
Authorized Official - First Name:RAOUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-616-8100
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-0012
Mailing Address - Country:US
Mailing Address - Phone:866-688-8613
Mailing Address - Fax:
Practice Address - Street 1:230 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2824
Practice Address - Country:US
Practice Address - Phone:201-410-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7052405Medicaid
NJ7052405Medicaid