Healthcare Provider Details

I. General information

NPI: 1669561007
Provider Name (Legal Business Name): DIAGNOSTIC PATHOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

PO BOX 66689
FALMOUTH ME
04105-6689
US

V. Phone/Fax

Practice location:
  • Phone: 888-724-7123
  • Fax:
Mailing address:
  • Phone: 866-689-8862
  • Fax: 207-347-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT RICKERT
Title or Position: CHIEF
Credential: MD
Phone: 973-322-5763