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General NPI Number Information
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NPI Number | 1760775886
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Entity Type | Organization
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Legal Business Name | TREASURE COAST PATHOLOGY LAB LLC
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 275 18TH STREET SUITE 101
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City | VERO BEACH
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State | FL
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Zip | 32960-5541
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Country | US
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Telephone | 772-299-5005
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Fax | 772-299-1340
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Provider Business Mailing Address
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Address Line | 275 18TH STREET SUITE 101
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City | VERO BEACH
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State | FL
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Zip | 32960-5541
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Country | US
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Telephone | 772-299-5005
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Fax | 772-299-1340
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | NEIL S. MEDALIE
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Credential | M.D.
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Telephone | 772-567-7088
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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 |
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License Number State |
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