Provider Demographics
NPI:1942357975
Name:LABORATORY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:LABORATORY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLITARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-229-8711
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-0417
Mailing Address - Country:US
Mailing Address - Phone:732-229-8711
Mailing Address - Fax:
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-229-8711
Practice Address - Fax:732-229-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA26631170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5471800Medicaid
NJB10753Medicare UPIN
NJ714072Medicare ID - Type Unspecified