Provider Demographics
NPI:1649998824
Name:NEXTGEN PATHOLOGY
Entity type:Organization
Organization Name:NEXTGEN PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZIJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-266-5725
Mailing Address - Street 1:PO BOX 526845
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33152-6845
Mailing Address - Country:US
Mailing Address - Phone:321-636-2211
Mailing Address - Fax:321-633-7085
Practice Address - Street 1:110 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2828
Practice Address - Country:US
Practice Address - Phone:321-636-2211
Practice Address - Fax:321-633-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty