Provider Demographics
NPI:1689846412
Name:ATLANTIS MEDICAL OFFICE BASED SURGERY, PLLC
Entity Type:Organization
Organization Name:ATLANTIS MEDICAL OFFICE BASED SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-663-6400
Mailing Address - Street 1:PO BOX 15546
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95852-0546
Mailing Address - Country:US
Mailing Address - Phone:516-663-6400
Mailing Address - Fax:516-663-6404
Practice Address - Street 1:200 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 100C
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3301
Practice Address - Country:US
Practice Address - Phone:516-663-6400
Practice Address - Fax:516-663-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical