Healthcare Provider Details

I. General information

NPI: 1215921549
Provider Name (Legal Business Name): ACUPATH LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/29/2024
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S TERMINAL DR
PLAINVIEW NY
11803-2309
US

IV. Provider business mailing address

28 S TERMINAL DR
PLAINVIEW NY
11803-2311
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-8103
  • Fax: 516-326-3455
Mailing address:
  • Phone: 516-394-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D0912240
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0898261
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier103825180-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier121508
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer
# 4
Identifier250022490
Identifier TypeMEDICAID
Identifier StateNV
Identifier Issuer
# 5
Identifier328502984A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 6
IdentifierL26201
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE BCBS
# 7
Identifier02067747
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 8
IdentifierQ080354
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: SHARON FOX
Title or Position: OWNER/PRESIDENT
Credential: AO
Phone: 516-775-8103