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General NPI Number Information
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NPI Number | 1710009626
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Entity Type | Organization
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Legal Business Name | PRINCETON PATHOLOGY SERVICES
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 CENTRAL AVE
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City | NEWARK
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State | NJ
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Zip | 07102-1909
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Country | US
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Telephone | 973-877-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 8 PLAYERS LN
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City | PRINCETON
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State | NJ
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Zip | 08540-2236
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Country | US
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Telephone | 609-647-1423
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIO GONZALEZ
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Credential |
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Telephone | 609-647-1423
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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 | 25MA07983800
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License Number State | NJ
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