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General NPI Number Information
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NPI Number | 1972694073
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Entity Type | Organization
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Legal Business Name | ATLANTIC PATHOLOGY GROUP, PA
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1335 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3127
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Country | US
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Telephone | 321-956-2986
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Fax | 321-956-9430
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Provider Business Mailing Address
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Address Line | 1335 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3127
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Country | US
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Telephone | 321-956-2986
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Fax | 321-956-9430
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Authorized Official
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Title or Position | M.D./MEDICAL DIRECTOR
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Name | DR. JOSE A REILOVA
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Credential | M.D.
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Telephone | 321-956-2986
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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 | 291U00000X
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License Number State | FL
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