NPIMap

Organization Active NPI

Physicians Dermpath Laboratory

  • Dermatopathology Physician
  • Park Ridge, IL
National Provider Identifier
1376866897
Registry record updated Nov 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
Legal business name
PHYSICIANS DERMPATH LABORATORY
Practice address
1420 N. Renaissance Dr.
Suite 204
Park Ridge, IL 60068-1330
Phone
(847) 768-2440
Fax
(847) 768-2443
NPI assigned
Mar 11, 2010
Last updated
Nov 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2010

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

Authorized official

Name
Dr. David A. Lorber, MDNPI 1699877175
Title
President
Phone
(847) 675-9711

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
Dermatopathology Physician 207ND0900X NU Primary

Addresses

Primary practice location

1420 N. Renaissance Dr.
Suite 204
Park Ridge, IL 60068-1330

Mailing address

1420 N. Renaissance Dr.
Suite 204
Park Ridge, IL 60068-1330
Phone (847) 768-2440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101109001405 IL Part B Supplier - Clinic/Group Practice 7315132974 Receives reassigned benefits from 4 practitioners
Practice locations: Park Ridge, IL

National Provider Directory

National Provider Directory

Locations

2622 Momentum Pl
Chicago, IL 60689

1420 Renaissance Dr
Park Ridge, IL 60068
Phone (847) 296-6161

Practitioners & affiliated clinicians

Practitioners 94

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 94

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289260800000",
    "number": "1376866897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 N. RENAISSANCE DR.",
            "address_2": "SUITE 204",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681330",
            "telephone_number": "847-768-2440",
            "fax_number": "847-768-2443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 N. RENAISSANCE DR.",
            "address_2": "SUITE 204",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681330",
            "telephone_number": "847-768-2440",
            "fax_number": "847-768-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS DERMPATH LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-11-09",
        "status": "A",
        "authorized_official_last_name": "LORBER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-675-9711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; 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.