Provider Demographics
NPI:1942474838
Name:DERMATOPATHOLOGY INSTITUTE OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:DERMATOPATHOLOGY INSTITUTE OF NEW JERSEY, LLC
Other - Org Name:OCEAN VIEW MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-450-0820
Mailing Address - Street 1:225 STATE ROUTE 35
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5919
Mailing Address - Country:US
Mailing Address - Phone:732-450-0820
Mailing Address - Fax:
Practice Address - Street 1:225 STATE ROUTE 35
Practice Address - Street 2:SUITE 201
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-450-0820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31D1064204OtherCLIA #
NJ31D1064204OtherCLIA #