Provider Demographics
NPI:1194797993
Name:AMERIPATH NEW YORK LLC
Entity type:Organization
Organization Name:AMERIPATH NEW YORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-733-7866
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1 GREENWICH PL
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4618
Practice Address - Country:US
Practice Address - Phone:866-436-9631
Practice Address - Fax:203-447-8666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07D1035411291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004250130Medicaid
OH2643769Medicaid
PA100771649003Medicaid
OK200279840AMedicaid
CO22339752Medicaid
NJ0093254Medicaid
GA015532634AMedicaid
TX176325201Medicaid
MD412163500Medicaid
SCL00237Medicaid
WV3810005215Medicaid
NC7001262Medicaid
CO22339752Medicaid
CTP000278090Medicare PIN