MEDICARE: CONSOLIDATED DERMPATH INC

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	291U00000X	Clinical Medical Laboratory	800001294	FL

General Provider Information

NPI Number	:	1417391749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSOLIDATED DERMPATH INC

Provider Business Mailing Address
First Line	:	500 PLAZA DR
Second Line	:
City	:	SECAUCUS
State	:	NJ
Zip	:	07094-3619
Country	:	US
Telephone Number	:	866-836-7136
Fax Number	:	954-633-3397

Provider Business Practice Location Address
First Line	:	1133 WESTCHESTER AVE STE 331
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3516
Country	:	US
Telephone Number	:	800-942-3376
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DARREN THOMAS WHEELER
Credential	:	MD
Telephone Number	:	973-520-2700

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	06/05/2026

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