NPIMap

Organization Active NPI

Pathology Consultants of New London, P.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • New London, CT
National Provider Identifier
1184655706
Registry record updated Oct 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY CONSULTANTS OF NEW LONDON, P.C.
Practice address
365 Montauk Ave
New London, CT 06320-4700
Phone
(860) 444-5100
Fax
(860) 444-3709
NPI assigned
Jul 5, 2006
Last updated
Oct 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2014

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

Authorized official

Name
Dr. Maria Victoria G Reyes, M.D.NPI 1598787517
Title
President
Phone
(203) 397-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

365 Montauk Ave
New London, CT 06320-4700

Mailing address

PO Box 902
New Haven, CT 06504-0902
Phone (203) 397-8000

Other identifiers 7

IdentifierTypeStateIssuer
032344OtherCTHEALTHNET GROUP#
004121133MedicaidCT
744026OtherCTCONNECTICARE GROUP#
C009155OtherCTTRI-CARE/CHAMPUS GROUP#
3193248OtherCTCIGNA GROUP#
2116927OtherCTAETNA/US HLTH GROUP#
500HBL160CT01OtherCTBC/BS GROUP#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100910000928 CT Part B Supplier - Clinic/Group Practice 0840369740 Receives reassigned benefits from 5 practitioners
Practice locations: New London, CT
O20130629000031 RI Part B Supplier - Clinic/Group Practice 0840369740 Receives reassigned benefits from 6 practitioners
Practice locations: Westerly, RI

National Provider Directory

National Provider Directory

Locations

365 Montauk Ave
Ste C408
New London, CT 06320

11 Research Dr
Ste 2
Woodbridge, CT 06525

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414108800000",
    "number": "1184655706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 902",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065040902",
            "telephone_number": "203-397-8000",
            "fax_number": "203-389-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204700",
            "telephone_number": "860-444-5100",
            "fax_number": "860-444-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY CONSULTANTS OF NEW LONDON, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2014-10-24",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "MARIA VICTORIA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-397-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET GROUP#",
            "identifier": "032344",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004121133",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE GROUP#",
            "identifier": "744026",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI-CARE/CHAMPUS GROUP#",
            "identifier": "C009155",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GROUP#",
            "identifier": "3193248",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/US HLTH GROUP#",
            "identifier": "2116927",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP#",
            "identifier": "500HBL160CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.