Provider Demographics
NPI:1932420411
Name:CLINICAL PATHOLOGY OF LONG ISLAND, PLLC
Entity Type:Organization
Organization Name:CLINICAL PATHOLOGY OF LONG ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-457-1806
Mailing Address - Street 1:135 LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4312
Mailing Address - Country:US
Mailing Address - Phone:516-457-1806
Mailing Address - Fax:
Practice Address - Street 1:135 LITTLE NECK RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4312
Practice Address - Country:US
Practice Address - Phone:516-457-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181348207ZP0102X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty