Provider Demographics
NPI:1801156062
Name:TRI-STATE PATHOLOGY CONSULTANTS, PA
Entity type:Organization
Organization Name:TRI-STATE PATHOLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ANNOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-757-3564
Mailing Address - Street 1:219 THOMAS AVE
Mailing Address - Street 2:ATTN: CREDENTIALING-COLEEN SCHICKLING
Mailing Address - City:RIVERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1225
Mailing Address - Country:US
Mailing Address - Phone:609-649-3261
Mailing Address - Fax:856-829-3107
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3564
Practice Address - Fax:856-757-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZB0001X, 207ZC0006X, 207ZC0500X, 207ZD0900X, 207ZH0000X, 207ZI0100X, 207ZM0300X, 207ZN0500X, 207ZP0101X, 207ZP0104X, 207ZP0105X, 207ZP0213X
NJ25MA09091300207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathologyGroup - Single Specialty
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical MicrobiologyGroup - Single Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Single Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical PathologyGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Single Specialty