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General NPI Number Information
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NPI Number | 1366460271
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Entity Type | Organization
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Legal Business Name | PATHOLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 300 CENTRAL AVE
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2819
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Country | US
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Telephone | 973-266-4444
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Fax | 973-266-2932
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Provider Business Mailing Address
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Address Line | 4567 CROSSROADS PARK DRIVE
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City | LIVERPOOL
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State | NY
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Zip | 13088-3589
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Country | US
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Telephone | 315-434-9309
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Fax | 315-454-0136
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SURESH KUMAR GUPTA
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Credential | M.D.
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Telephone | 973-266-4444
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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 | 25MA04299600
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License Number State | NJ
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