Provider Demographics
NPI:1871761080
Name:LABORATORY OF DERMATOPATHOLOGY, LLP
Entity type:Organization
Organization Name:LABORATORY OF DERMATOPATHOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEFANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-944-3882
Mailing Address - Street 1:2 N PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3443
Mailing Address - Country:US
Mailing Address - Phone:516-944-3882
Mailing Address - Fax:
Practice Address - Street 1:2 N PLANDOME RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3443
Practice Address - Country:US
Practice Address - Phone:516-944-3882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURORA DIAGNOSTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty