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General NPI Number Information
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NPI Number | 1407246887
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Entity Type | Organization
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Legal Business Name | ATLANTIC BIOTECH, LLC.
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 1501 GREEN RD SUITE A
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City | POMPANO BEACH
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State | FL
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Zip | 33064-1077
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Country | US
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Telephone | 754-222-5150
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Fax | 954-482-0125
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Provider Business Mailing Address
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Address Line | 1501 GREEN RD SUITE A
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City | POMPANO BEACH
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State | FL
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Zip | 33064-1077
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Country | US
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Telephone | 754-222-5150
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Fax | 954-482-0125
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Authorized Official
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Title or Position | C.O.O.
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Name | GORAN JANDJEL
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Credential |
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Telephone | 754-222-5150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2087683
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License Number State | FL
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