Healthcare Provider Details

I. General information

NPI: 1356989388
Provider Name (Legal Business Name): PRIME PATHOLOGY LABORATORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5062
US

IV. Provider business mailing address

196 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5062
US

V. Phone/Fax

Practice location:
  • Phone: 347-352-9644
  • Fax:
Mailing address:
  • Phone: 516-457-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALI TAMSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 516-457-1806