Provider Demographics
NPI:1619287398
Name:PATHOLOGY ASSOCIATES OF CENTRAL JERSEY INC.
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF CENTRAL JERSEY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-324-5171
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0736
Mailing Address - Country:US
Mailing Address - Phone:732-324-5171
Mailing Address - Fax:732-324-4999
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3654
Practice Address - Country:US
Practice Address - Phone:732-324-5171
Practice Address - Fax:732-324-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67626207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8069204Medicaid
NY02909108Medicaid
NJ0158763Medicaid
NJ8069204Medicaid
NY02909108Medicaid
106364CBOMedicare Oscar/Certification
NJ033955Medicare PIN