Provider Demographics
NPI:1164660643
Name:ATLANTIC DIAGNOSTICS LABORATORIES
Entity Type:Organization
Organization Name:ATLANTIC DIAGNOSTICS LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PASCHAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-858-8801
Mailing Address - Street 1:1570 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4500
Mailing Address - Country:US
Mailing Address - Phone:215-858-8801
Mailing Address - Fax:
Practice Address - Street 1:1570 GARRETT RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4500
Practice Address - Country:US
Practice Address - Phone:215-858-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DIAGNOSTICS LABORATORIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024997291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory