=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134191927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERIPATH NEW YORK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2006
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 E 32ND ST 10TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-6055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-889-6225
-----------------------------------------------------
Fax | 212-889-8268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14275 MIDWAY RD SUITE 400
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-3614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-932-8029
-----------------------------------------------------
Fax | 610-271-4245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | KRISTIE M DOLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-697-8378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 33D0961556
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------