MEDICARE: CLINICAL PATHOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1003963604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL PATHOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	1425 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6514
Country	:	US
Telephone Number	:	212-241-2905
Fax Number	:	631-723-1636

Provider Business Practice Location Address
First Line	:	1425 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6514
Country	:	US
Telephone Number	:	212-241-2905
Fax Number	:	631-723-1636

Authorized Official
Title or Position	:	CEO DEAN OF CLINICAL AFFAIRS
Name	:	DR. LOUIS RUSSO
Credential	:	M.D.
Telephone Number	:	212-241-0087

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

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