Provider Demographics
NPI:1366420010
Name:BRONXVILLE PATHOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:BRONXVILLE PATHOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACCERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-771-5887
Mailing Address - Street 1:17 KRAFT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4103
Mailing Address - Country:US
Mailing Address - Phone:914-771-5887
Mailing Address - Fax:914-771-7106
Practice Address - Street 1:55 PALMER RD
Practice Address - Street 2:LAWRENCE HOSPITAL CENTER
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4103
Practice Address - Country:US
Practice Address - Phone:914-787-3265
Practice Address - Fax:914-787-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141707207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP-52352515OtherMULTIPLAN
NYCH9453Medicare ID - Type UnspecifiedMEDICARE RAILROAD
NYP-52352515OtherMULTIPLAN