Provider Demographics
NPI:1699175760
Name:AMERIPATH NEW YORK, LLC
Entity Type:Organization
Organization Name:AMERIPATH NEW YORK, LLC
Other - Org Name:DERMPATH DIAGNOSTICS NEW ENGLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-550-3003
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:844-362-9801
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:200 FOREST ST
Practice Address - Street 2:SUITE 3119
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3023
Practice Address - Country:US
Practice Address - Phone:884-362-9801
Practice Address - Fax:774-843-3737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-26
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory