Provider Demographics
NPI:1922258722
Name:ICON PATHOLOGY LABORATORY, LLC
Entity Type:Organization
Organization Name:ICON PATHOLOGY LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ARPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-662-7732
Mailing Address - Street 1:145 TALMADGE RD STE 17
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2842
Mailing Address - Country:US
Mailing Address - Phone:732-662-7732
Mailing Address - Fax:
Practice Address - Street 1:145 TALMADGE RD STE 17
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2842
Practice Address - Country:US
Practice Address - Phone:732-662-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory