Provider Demographics
NPI:1417355678
Name:ATLANTIC DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:ATLANTIC DIAGNOSTICS LLC
Other - Org Name:ATLANTIC DIAGNOSTICS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SAVVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-905-6441
Mailing Address - Street 1:5930 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4306
Mailing Address - Country:US
Mailing Address - Phone:310-905-6441
Mailing Address - Fax:213-559-0676
Practice Address - Street 1:124 9TH ST STE 260
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3706
Practice Address - Country:US
Practice Address - Phone:332-208-8824
Practice Address - Fax:332-262-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D2069816291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D2152435OtherCLIA ID