=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730153578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHEAST PATHOLOGY SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2006
-----------------------------------------------------
Last Update Date | 12/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 670 STONELEIGH AVE
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512-3997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-562-7995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4264
-----------------------------------------------------
City | NEW WINDSOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12553-0264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-562-7995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. VINITA AGARWAL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 845-562-7995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------