Organization
FPA HOSPITAL BASED
Active
Parent organization
FPA HOSPITAL BASED
Other names
MOUNT SINAI DERMATOPATHOLOGY SERVICES III
Organization subpart
Yes
Provider details
NPI number
Legal business name
FPA HOSPITAL BASED
Authorized official
MS. CRYSTAL MACNEILL MBA (VP, CBO DIRECTOR)
(212) 241-6228
Entity
Organization
Contact information
Practice address
1468 MADISON AVE, ANNENBERG 03-08, NEW YORK, NY 10029-6508
(212) 731-7772
(212) 534-7491
Mailing address
1468 MADISON AVE, ANNENBERG 03-08, NEW YORK, NY 10029-6508
(212) 241-6064
(212) 241-7832
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
CLIA 33D1051889
NY
Other
Enumeration date
03/01/2013
Last updated
03/02/2015
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