Provider Demographics
NPI:1275991267
Name:ELISA/ACT BIOTECHNOLOGIES
Entity Type:Organization
Organization Name:ELISA/ACT BIOTECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-450-2980
Mailing Address - Street 1:109 CARPENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-7115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 CARPENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-7115
Practice Address - Country:US
Practice Address - Phone:703-450-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory