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General NPI Number Information
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NPI Number | 1417355678
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Entity Type | Organization
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Legal Business Name | ATLANTIC DIAGNOSTICS LLC
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 124 9TH ST STE 260
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City | BROOKLYN
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State | NY
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Zip | 11215-3706
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Country | US
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Telephone | 332-208-8824
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Fax | 332-262-5789
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Provider Business Mailing Address
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Address Line | 5930 W JEFFERSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90016-4306
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Country | US
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Telephone | 310-905-6441
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Fax | 213-559-0676
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | MICHAEL GEORGE SAVVIDES
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Credential |
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Telephone | 310-905-6441
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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 | 33D2069816
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License Number State | NY
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