Provider Demographics
NPI:1679605612
Name:ATLANTIC HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ATLANTIC HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:FAHIM
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-535-3999
Mailing Address - Street 1:19 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3370
Mailing Address - Country:US
Mailing Address - Phone:908-575-7332
Mailing Address - Fax:908-575-7336
Practice Address - Street 1:107 E MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3027
Practice Address - Country:US
Practice Address - Phone:973-535-3999
Practice Address - Fax:973-535-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079157002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098011XY4Medicare PIN