Healthcare Provider Details

I. General information

NPI: 1871761080
Provider Name (Legal Business Name): LABORATORY OF DERMATOPATHOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N PLANDOME RD
PORT WASHINGTON NY
11050-3443
US

IV. Provider business mailing address

2 N PLANDOME RD
PORT WASHINGTON NY
11050-3443
US

V. Phone/Fax

Practice location:
  • Phone: 516-944-3882
  • Fax:
Mailing address:
  • Phone: 516-944-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN J STEFANELLI
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 516-944-3882