Provider Demographics
NPI:1417224940
Name:ELITE HEMATOPATHOLOGY, LLC
Entity Type:Organization
Organization Name:ELITE HEMATOPATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-945-7796
Mailing Address - Street 1:1075 CALLE MARGINAL VILLAMAR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 CALLE MARGINAL VILLAMAR
Practice Address - Street 2:SUITE 3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6300
Practice Address - Country:US
Practice Address - Phone:787-945-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZH0000X
PR1278291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHA822AMedicare PIN