Provider Demographics
NPI:1619951621
Name:PALM BEACH PATHOLOGY PA
Entity Type:Organization
Organization Name:PALM BEACH PATHOLOGY PA
Other - Org Name:ST MARYS PATHOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-659-0770
Mailing Address - Street 1:300 BUTLER STREET
Mailing Address - Street 2:PALM BEACH PATHOLOGY PA
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6006
Mailing Address - Country:US
Mailing Address - Phone:561-659-0770
Mailing Address - Fax:561-802-3504
Practice Address - Street 1:2013 PONCE DELEON AVE
Practice Address - Street 2:PALM BEACH PATHOLOGY PA
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6019
Practice Address - Country:US
Practice Address - Phone:561-659-0770
Practice Address - Fax:561-802-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258264300Medicaid
FL99070Medicare PIN
FL258264300Medicaid
FL99268Medicare PIN
FL77313Medicare PIN
FL97880Medicare PIN
FL99071Medicare PIN