Provider Demographics
NPI:1801017751
Name:JERSEY CITY PATHOLOGY GROUP, PA
Entity Type:Organization
Organization Name:JERSEY CITY PATHOLOGY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:YOGINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-795-5963
Mailing Address - Street 1:176 PALISADE AVE
Mailing Address - Street 2:CHRIST HOSPITAL
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1121
Mailing Address - Country:US
Mailing Address - Phone:201-795-5963
Mailing Address - Fax:201-795-8118
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:CHRIST HOSPITAL
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-795-5963
Practice Address - Fax:201-795-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3406300Medicaid
NJ565751Medicare ID - Type Unspecified