Corona Pathology CPS Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

BT-1006112 Issued in CA

Legal business name

CORONA PATHOLOGY CPS INC.

Practice address

4444 Riverside Dr.
Suite 308
Burbank, CA 91505-4073

Phone

(818) 566-1891

Fax

(818) 566-8834

NPI assigned

Sep 18, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Hershel Tsikman

Title

Officer

Phone

(818) 402-8060

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Corona Pathology Services, Inc. Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1073949327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 RIVERSIDE DR.",
            "address_2": "SUITE 308",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054073",
            "telephone_number": "818-566-1891",
            "fax_number": "818-566-8834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 RIVERSIDE DR.",
            "address_2": "SUITE 308",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054073",
            "telephone_number": "818-566-1891",
            "fax_number": "818-566-8834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORONA PATHOLOGY CPS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-18",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "TSIKMAN",
        "authorized_official_first_name": "HERSHEL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "818-402-8060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "BT-1006112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0879836",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corona Pathology Services, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Medical Laboratory in Burbank, CA
• Providers in Burbank, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.