Provider Demographics
NPI:1063433860
Name:UNIVERSITY PATHOLOGISTS LABORATORIES, LLP
Entity type:Organization
Organization Name:UNIVERSITY PATHOLOGISTS LABORATORIES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:THREATTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-464-6751
Mailing Address - Street 1:250 HARRISON ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3065
Mailing Address - Country:US
Mailing Address - Phone:315-464-6751
Mailing Address - Fax:315-464-6749
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3096
Practice Address - Country:US
Practice Address - Phone:315-464-6751
Practice Address - Fax:315-464-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPFI3697291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01018973Medicaid
NY50624BMedicare ID - Type Unspecified