NPIMap

Organization Active NPI

Quest Diagnostics of Pennsylvania Inc.

  • Clinical Medical Laboratory
  • North Syracuse, NY
National Provider Identifier
1336167964
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
33D0654945 Issued in NY
Legal business name
QUEST DIAGNOSTICS OF PENNSYLVANIA INC.
Practice address
200 Gateway Park Dr
BLDG a
North Syracuse, NY 13212-3751
Phone
(315) 458-5592
NPI assigned
Jul 18, 2006
Last updated
Oct 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
QUEST DIAGNOSTICS INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
Charles Albert Bowles
Title
Vice President
Phone
(610) 454-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 33D0654945 NY Primary

Addresses

Primary practice location

200 Gateway Park Dr
BLDG a
North Syracuse, NY 13212-3751

Mailing address

1201 S Collegeville Rd
Collegeville, PA 19426-2998
Phone (610) 454-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071203000148 NY Part B Supplier - Independent Clinical Laboratory 2365345550 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Syracuse, NY; West Amherst, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0654945Quest Diagnostics of Pennsylvania200 Gateway Park Drive BLDG a, North Syracuse, NY 13212ComplianceMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
MDS Laboratories8 organizations share this tax ID, including this one
Part of
Quest Diagnostics Inc P

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5750 Collection Ctr Dr
Chicago, IL 60693

200 Gateway Park Dr
Bldg A
Syracuse, NY 13212
Phone (315) 458-5592

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1336167964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S COLLEGEVILLE RD",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194262998",
            "telephone_number": "610-454-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GATEWAY PARK DR",
            "address_2": "BLDG A",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132123751",
            "telephone_number": "315-458-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEST DIAGNOSTICS OF PENNSYLVANIA INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUEST DIAGNOSTICS INCORPORATED",
        "enumeration_date": "2006-07-18",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "BOWLES",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "610-454-6000"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "33D0654945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.