NPIMap

Organization Active NPI

Pinkus Dermatopathology Laboratory, PC

  • Clinical Medical Laboratory
  • Monroe, MI
National Provider Identifier
1346223377
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PINKUS DERMATOPATHOLOGY LABORATORY, PC
Practice address
1314 N Macomb St
Monroe, MI 48162-3131
Phone
(734) 242-6872
Fax
(734) 242-4962
NPI assigned
Nov 23, 2005
Last updated
Feb 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Dina Valladares
Title
Director
Phone
(561) 514-5822

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

1314 N Macomb St
Monroe, MI 48162-3131

Mailing address

1355 River Bend Dr
Dallas, TX 75247-4915
Phone (734) 242-6872

Other identifiers 1

IdentifierTypeStateIssuer
1017853MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040928000304 MI Part B Supplier - Clinic/Group Practice 8921077884 Receives reassigned benefits from 13 practitioners
Practice locations: Monroe, MI

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
23D0650651Pinkus Dermatopathology Laboratory1314 N Macomb St, Monroe, MI 48162AccreditationMar 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pinkus Dermatopathology Laboratory2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

16250 NW 59th Ave
Ste 201
Miami Lakes, FL 33014
Phone (305) 825-4422

16344 Collections Cntr Dr
Chicago, IL 60693

16344 Collections Ctr D
Chicago, IL 60693

16344 Collections Dr
Chicago, IL 60693

1314 N Macomb St
Monroe, MI 48162
Phone (734) 242-6872

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1346223377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 RIVER BEND DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752474915",
            "telephone_number": "734-242-6872",
            "fax_number": "734-242-4962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623131",
            "telephone_number": "734-242-6872",
            "fax_number": "734-242-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINKUS DERMATOPATHOLOGY LABORATORY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "VALLADARES",
        "authorized_official_first_name": "DINA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "561-514-5822"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017853",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.