P4 Clinical LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

0003775 Issued in NJ

Legal business name

P4 CLINICAL LLC

Practice address

25 Riverside Dr Unit 10
Pine Brook, NJ 07058-9391

Phone

(862) 803-1079

NPI assigned

Oct 11, 2017

Last updated

Jul 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sathish Kothandaram

Title

President & Ceo

Phone

(702) 727-6466

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, TX2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Chiraag D Patel, M.D.

  • Molecular Genetic Pathology (Pathology) Physician
  • Beltsville, MD
  • NPI 1528386232

  Anatomic Pathology & Clinical Pathology

  NPD (past)

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1447760814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 VIRGINIA MANOR RD STE 170",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207054230",
            "telephone_number": "301-715-3805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 RIVERSIDE DR UNIT 10",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589391",
            "telephone_number": "862-803-1079"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3201 Cherry Ridge Dr Ste D402",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782304820",
            "country_code": "US",
            "telephone_number": "301-928-5639",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16420 Park Ten Pl Ste 150",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770845097",
            "country_code": "US",
            "telephone_number": "301-928-5639",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12005 Ford Rd Ste 540",
            "address_purpose": "LOCATION",
            "city": "Farmers Branch",
            "state": "TX",
            "postal_code": "752347269",
            "country_code": "US",
            "telephone_number": "301-928-5639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "P4 CLINICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "KOTHANDARAM",
        "authorized_official_first_name": "SATHISH",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "702-727-6466",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NJ",
            "license": "0003775",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "0003775",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Pine Brook, NJ
• Providers in Pine Brook, NJ by specialty
• Clinical Medical Laboratory in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.