MEDICARE: UNIVERSITY PATHOLOGISTS LABORATORIES, LLP

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	291U00000X	Clinical Medical Laboratory	PFI3697	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063433860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PATHOLOGISTS LABORATORIES, LLP

Provider Business Mailing Address
First Line	:	250 HARRISON ST
Second Line	:	SUITE 502
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3065
Country	:	US
Telephone Number	:	315-464-6751
Fax Number	:	315-464-6749

Provider Business Practice Location Address
First Line	:	550 HARRISON ST
Second Line	:	SUITE 220
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3096
Country	:	US
Telephone Number	:	315-464-6751
Fax Number	:	315-464-6749

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY THREATTE
Credential	:	MD
Telephone Number	:	315-464-6751

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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