Provider Demographics
NPI:1932290913
Name:AMERIPATH NEW YORK LLC
Entity Type:Organization
Organization Name:AMERIPATH NEW YORK LLC
Other - Org Name:DERMPATH DIAGNOSTICS NEW ENGLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-550-3000
Mailing Address - Street 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4207
Mailing Address - Country:US
Mailing Address - Phone:561-712-6265
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:10 FORBES RD
Practice Address - Street 2:SUITE 260E
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2605
Practice Address - Country:US
Practice Address - Phone:866-370-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0800228Medicaid
MA22D2004456OtherCLIA
MA22D2004456OtherCLIA