Organization
MAPLEWOOD PATHOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISLE EATON MD (PRESIDENT)
(518) 525-1424
Entity
Organization
Contact information
Practice address
315 S MANNING BLVD, SPH PATHOLOGY, ALBANY, NY 12208-1707
(518) 525-1474
(518) 525-6750
Mailing address
PO BOX 8870, MAPLEWOOD PATHOLOGY, ALBANY, NY 12208-0870
(518) 525-1424
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33D0162320
CLIA
NY
01
—
33DPFI0004
CLIA
NY
Enumeration date
08/15/2005
Last updated
04/09/2014
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