Organization
P4 CLINICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SATHISH KOTHANDARAM (PRESIDENT & CEO)
(702) 727-6466
Entity
Organization
Contact information
Practice address
25 RIVERSIDE DR UNIT 10, PINE BROOK, NJ 07058-9391
(862) 803-1079
Mailing address
8000 VIRGINIA MANOR RD STE 170, BELTSVILLE, MD 20705-4230
(301) 715-3805
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
0003775
NJ
291U00000X
Clinical Medical Laboratory
Primary
0003775
NJ
Other
Enumeration date
10/11/2017
Last updated
07/19/2024
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