Provider Demographics
NPI:1285771022
Name:NASSAU PATHOLOGY PC
Entity type:Organization
Organization Name:NASSAU PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONARVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-454-4080
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0010
Mailing Address - Country:US
Mailing Address - Phone:631-454-4080
Mailing Address - Fax:631-454-4088
Practice Address - Street 1:32 JOHN BEAN CT
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4629
Practice Address - Country:US
Practice Address - Phone:631-454-4080
Practice Address - Fax:631-454-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1175161291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1175161OtherLICENSE