Provider Demographics
NPI:1982926010
Name:INDEPENDENT DERMATOPATHOLOGY, P.C.
Entity type:Organization
Organization Name:INDEPENDENT DERMATOPATHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-629-8756
Mailing Address - Street 1:216 CONGERS RD
Mailing Address - Street 2:BLDG 2 SUITE A
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6261
Mailing Address - Country:US
Mailing Address - Phone:914-629-8756
Mailing Address - Fax:
Practice Address - Street 1:216 CONGERS RD
Practice Address - Street 2:BLDG 2 SUITE A
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6261
Practice Address - Country:US
Practice Address - Phone:914-629-8756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8434291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory