Provider Demographics
NPI:1467595876
Name:MEDICAL LABORATORY & PATHOLOGY CONSULTANTS LLC
Entity Type:Organization
Organization Name:MEDICAL LABORATORY & PATHOLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SETOODEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-365-4565
Mailing Address - Street 1:65 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:973-365-4595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL LABORATORY AND PATHOLOGY CONSULTANTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8851506Medicaid
NJ8851506Medicaid