Provider Demographics
NPI:1376774935
Name:ATLANTIC EXPRESS CO INC
Entity Type:Organization
Organization Name:ATLANTIC EXPRESS CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-829-1271
Mailing Address - Street 1:4252 BONITA RD
Mailing Address - Street 2:SUITE 82
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4252 BONITA RD
Practice Address - Street 2:SUITE 82
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1420
Practice Address - Country:US
Practice Address - Phone:619-829-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33408207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG583AMedicare PIN