Provider Demographics
NPI:1932413002
Name:LONG ISLAND PATHOLOGY INC
Entity Type:Organization
Organization Name:LONG ISLAND PATHOLOGY INC
Other - Org Name:P4 DIAGNOSTIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHANDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-298-5960
Mailing Address - Street 1:10 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4063
Mailing Address - Country:US
Mailing Address - Phone:631-675-1777
Mailing Address - Fax:631-675-1772
Practice Address - Street 1:10 TECHNOLOGY DR
Practice Address - Street 2:UNIT 2
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4063
Practice Address - Country:US
Practice Address - Phone:631-675-1777
Practice Address - Fax:631-675-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300035733Medicare PIN