MEDICARE: PECONIC PATHOLOGY ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1265523708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PECONIC PATHOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	1900 HEMPSTEAD TPKE
Second Line	:	SUITE 500
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-1724
Country	:	US
Telephone Number	:	516-542-1090
Fax Number	:	516-794-8165

Provider Business Practice Location Address
First Line	:	1300 ROANOKE AVENUE
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2058
Country	:	US
Telephone Number	:	800-326-6222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANJANA MATHUR
Credential	:	MD
Telephone Number	:	800-326-6222

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	10/02/2014

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