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General NPI Number Information
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NPI Number | 1043433519
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Entity Type | Organization
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Legal Business Name | PECONIC PATHOLOGY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 201 MANOR PL EASTERN LONG ISLAND HOSPITAL
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City | GREENPORT
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State | NY
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Zip | 11944-1222
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Country | US
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Telephone | 631-548-6146
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Fax | 631-548-6150
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Provider Business Mailing Address
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Address Line | 160 WENTWORTH AVE
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City | ALBERTSON
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State | NY
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Zip | 11507-1727
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Country | US
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Telephone | 516-248-5245
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Fax | 516-248-7195
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANJANA MATHUR
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Credential | M.D.
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Telephone | 516-248-5245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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