Provider Demographics
NPI:1124386065
Name:ATLANTIC BONE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ATLANTIC BONE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYSHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-422-4263
Mailing Address - Street 1:4263 ELK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2563
Mailing Address - Country:US
Mailing Address - Phone:410-422-4263
Mailing Address - Fax:
Practice Address - Street 1:4263 ELK CREEK DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2563
Practice Address - Country:US
Practice Address - Phone:410-422-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-29
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR041641363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty