Healthcare Provider Details

I. General information

NPI: 1962737726
Provider Name (Legal Business Name): GOLD COAST PATHOLOGY & LABORATORY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLE ST
ROSLYN HEIGHTS NY
11577-1940
US

IV. Provider business mailing address

100 MAPLE ST
ROSLYN HEIGHTS NY
11577-1940
US

V. Phone/Fax

Practice location:
  • Phone: 516-458-1405
  • Fax: 516-801-3810
Mailing address:
  • Phone: 516-458-1405
  • Fax: 516-801-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SADAF SHEIKH
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 516-458-1405