Provider Demographics
NPI:1063055200
Name:SEPA LAB - BRISTOL
Entity type:Organization
Organization Name:SEPA LAB - BRISTOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:FALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-235-7246
Mailing Address - Street 1:721 DRESHER RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2218
Mailing Address - Country:US
Mailing Address - Phone:855-235-7246
Mailing Address - Fax:215-702-7075
Practice Address - Street 1:200 RITTENHOUSE CIRCLE
Practice Address - Street 2:STE 1A EAST
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-1619
Practice Address - Country:US
Practice Address - Phone:855-235-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S.E. PA PAIN MANAGEMENT LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty