Provider Demographics
NPI:1467481564
Name:EASTERN GREAT LAKES PATHOLOGY PC
Entity Type:Organization
Organization Name:EASTERN GREAT LAKES PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-862-1833
Mailing Address - Street 1:20 NORTHPOINTE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-6801
Mailing Address - Country:US
Mailing Address - Phone:716-529-3990
Mailing Address - Fax:165-293-9927
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-862-1833
Practice Address - Fax:716-529-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12249AMedicare PIN