Provider Demographics
NPI:1871707018
Name:STATEN ISLAND UNIVERSITY HOSPITAL PATHOLOGY GROUP
Entity type:Organization
Organization Name:STATEN ISLAND UNIVERSITY HOSPITAL PATHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-226-4502
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-4502
Mailing Address - Fax:718-226-4875
Practice Address - Street 1:1 EDGEWATER PLAZA
Practice Address - Street 2:1ST FLOOR - LABORATORY
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4900
Practice Address - Country:US
Practice Address - Phone:718-226-4502
Practice Address - Fax:718-226-4875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATEN ISLAND UNIVERSITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWS421Medicare PIN