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General NPI Number Information
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NPI Number | 1053530402
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Entity Type | Organization
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Legal Business Name | ON-SITE PATHOLOGY LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 951 BROKEN SOUND PKWY NW STE 115
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City | BOCA RATON
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State | FL
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Zip | 33487-3507
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Country | US
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Telephone | 561-989-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 951 BROKEN SOUND PKWY NW STE 115
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City | BOCA RATON
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State | FL
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Zip | 33487-3507
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Country | US
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Telephone | 561-989-0027
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY QUEEN
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Credential |
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Telephone | 561-989-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800020612
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License Number State | FL
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