Provider Demographics
NPI:1831589738
Name:IDEAL PATHOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:IDEAL PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ESPINAL-MARIOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-720-5733
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-1466
Mailing Address - Country:US
Mailing Address - Phone:414-258-9511
Mailing Address - Fax:414-607-3946
Practice Address - Street 1:307 HAMBURG TPKE
Practice Address - Street 2:SUITE 1A
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2142
Practice Address - Country:US
Practice Address - Phone:973-720-5733
Practice Address - Fax:973-720-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty