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General NPI Number Information
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NPI Number | 1275588576
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Entity Type | Organization
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Legal Business Name | ADVANCED PATHOLOGY LABORATORY LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 334 W OAKCREST AVE
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1716
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Country | US
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Telephone | 609-646-7000
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Fax | 609-646-7140
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Provider Business Mailing Address
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Address Line | 334 W OAKCREST AVE
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1716
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Country | US
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Telephone | 609-646-7000
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Fax | 609-646-7140
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALI DANESHVAR
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Credential | M.D.
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Telephone | 609-646-7000
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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 | 00003933
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License Number State | NJ
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