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General NPI Number Information
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NPI Number | 1255964185
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Entity Type | Organization
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Legal Business Name | PINKUS DERMATOPATHOLOGY LABORATORY, PC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 1314 N MACOMB ST
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City | MONROE
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State | MI
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Zip | 48162-3131
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Country | US
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Telephone | 616-530-1860
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Fax |
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Provider Business Mailing Address
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Address Line | 11025 RCA CENTER DR STE 300
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4269
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Country | US
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Telephone | 561-514-5822
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PAYER ENROLLMENT
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Name | DINA VALLADARES
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Credential |
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Telephone | 561-514-5822
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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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