Provider Demographics
NPI:1043238918
Name:ATLANTIS MEDICAL ASSOCIATE PC
Entity Type:Organization
Organization Name:ATLANTIS MEDICAL ASSOCIATE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRIOPETER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:P
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:718-237-4067
Mailing Address - Street 1:481 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1889
Mailing Address - Country:US
Mailing Address - Phone:718-237-4067
Mailing Address - Fax:718-596-2598
Practice Address - Street 1:481 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1889
Practice Address - Country:US
Practice Address - Phone:718-237-4067
Practice Address - Fax:718-596-2598
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROMEO JONES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00727197Medicaid
NYC11875Medicare UPIN