Provider Demographics
NPI:1639405764
Name:AVANTE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:AVANTE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAGIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-971-5612
Mailing Address - Street 1:65 MADISON AVE
Mailing Address - Street 2:SUITE #220
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7354
Mailing Address - Country:US
Mailing Address - Phone:973-538-3050
Mailing Address - Fax:973-538-5320
Practice Address - Street 1:25 POCONO RD
Practice Address - Street 2:SAINT CLARES HOSPITAL DEPARTMENT OF PATHOLOGY
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2954
Practice Address - Country:US
Practice Address - Phone:973-625-6716
Practice Address - Fax:973-983-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-24
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04232900207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty