Provider Demographics
NPI:1528022142
Name:PATHOLOGY ASSOCIATES OF NE PA LTD
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF NE PA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-558-4560
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0898
Mailing Address - Country:US
Mailing Address - Phone:570-558-4560
Mailing Address - Fax:570-558-4564
Practice Address - Street 1:781 KEYSTONE INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1530
Practice Address - Country:US
Practice Address - Phone:570-558-4560
Practice Address - Fax:570-558-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00097011100007Medicaid
CG0134OtherRR MC
PA00097011100007Medicaid