Provider Demographics
NPI:1710512389
Name:PATH ANALYTICS LABORATORY LLC
Entity Type:Organization
Organization Name:PATH ANALYTICS LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIMCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-476-8761
Mailing Address - Street 1:14500 N NORTHSIGHT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3659
Mailing Address - Country:US
Mailing Address - Phone:888-980-7477
Mailing Address - Fax:480-265-4465
Practice Address - Street 1:13402 N SCOTTSDALE RD STE B195
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4066
Practice Address - Country:US
Practice Address - Phone:888-980-7477
Practice Address - Fax:480-265-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory