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General NPI Number Information
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NPI Number | 1982926010
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DERMATOPATHOLOGY, P.C.
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 216 CONGERS RD BLDG 2 SUITE A
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City | NEW CITY
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State | NY
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Zip | 10956-6261
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Country | US
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Telephone | 914-629-8756
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Fax |
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Provider Business Mailing Address
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Address Line | 216 CONGERS RD BLDG 2 SUITE A
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City | NEW CITY
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State | NY
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Zip | 10956-6261
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Country | US
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Telephone | 914-629-8756
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SCOTT SANDERS
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Credential | MD
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Telephone | 914-629-8756
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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 | 8434
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License Number State | NY
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