Organization
FPA HOSPITAL BASED
Active
Parent organization
FPA HOSPITAL BASED
Other names
MOUNT SINAI PATHOLOGY OUTREACH
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 15-60, NEW YORK, NY 10029-6508
(212) 731-7772
(212) 534-7491
Mailing address
1468 MADISON AVE, ANNENBERG 15-60, NEW YORK, NY 10029-6508
(212) 731-7772
(212) 534-7491
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
CLIA 33D1051889
NY
207ZC0500X
Cytopathology Physician
CLIA 33D1051889
NY
207ZF0201X
Forensic Pathology Physician
CLIA 33D1051889
NY
207ZI0100X
Immunopathology Physician
CLIA 33D1051889
NY
207ZN0500X
Neuropathology Physician
CLIA 33D1051889
NY
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
CLIA 33D1051889
NY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
CLIA 33D1051889
NY
207ZP0213X
Pediatric Pathology Physician
CLIA 33D1051889
NY
Other
Enumeration date
03/06/2013
Last updated
02/27/2015
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