Healthcare Provider Details

I. General information

NPI: 1104868512
Provider Name (Legal Business Name): ELISA/ACT BIOTECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PIDGEON HILL DR SUITE 300
STERLING VA
20165-6155
US

IV. Provider business mailing address

14 PIDGEON HILL DR SUITE 300
STERLING VA
20165-6155
US

V. Phone/Fax

Practice location:
  • Phone: 703-788-5101
  • Fax: 703-450-2981
Mailing address:
  • Phone: 703-788-5101
  • Fax: 703-450-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. RUSSELL MERRIT JAFFE
Title or Position: PRESIDENT/ CEO
Credential: MD
Phone: 703-788-5111