Healthcare Provider Details

I. General information

NPI: 1558276675
Provider Name (Legal Business Name): PILGRIM MEDICAL CENTER LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 BLOOMFIELD AVE
MONTCLAIR NJ
07042-3741
US

IV. Provider business mailing address

393 BLOOMFIELD AVE
MONTCLAIR NJ
07042-3741
US

V. Phone/Fax

Practice location:
  • Phone: 973-746-8181
  • Fax: 973-746-0937
Mailing address:
  • Phone: 973-746-8181
  • Fax: 973-746-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLE KOTOPOULOS
Title or Position: CFO/ ADMINISTRATOR
Credential:
Phone: 973-746-8181