Provider Demographics
NPI:1407246887
Name:ATLANTIC BIOTECH, LLC.
Entity Type:Organization
Organization Name:ATLANTIC BIOTECH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:GORAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDJEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-222-5150
Mailing Address - Street 1:1501 GREEN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1077
Mailing Address - Country:US
Mailing Address - Phone:754-222-5150
Mailing Address - Fax:954-482-0125
Practice Address - Street 1:1501 GREEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1077
Practice Address - Country:US
Practice Address - Phone:754-222-5150
Practice Address - Fax:954-482-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2087683291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2087683OtherCLIA