Organization
MOUNTAIN LAKES PATHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESSAM AHMED MD (PRINCIPAL OWNER)
(973) 831-5046
Entity
Organization
Contact information
Practice address
115 ROUTE 46 W, SUITE B-12, MOUNTAIN LAKES, NJ 07046-1668
(973) 809-7706
Mailing address
115 ROUTE 46 W, SUITE B-12, MOUNTAIN LAKES, NJ 07046-1668
(973) 809-7706
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8065301
—
NJ
05
—
8606005
—
NJ
Enumeration date
07/28/2011
Last updated
07/28/2011
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