Provider Demographics
NPI:1720125222
Name:PATHOLOGY ASSOCIATES OF DELAWARE VALLEY, PC
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF DELAWARE VALLEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-895-0933
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:5-110
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-895-0933
Mailing Address - Fax:
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:5-110
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-895-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3399401Medicaid
NJ579844Medicare ID - Type Unspecified
NJ3399401Medicaid