Provider Demographics
NPI:1245285634
Name:ATLANTIC LITHOTRIPSY
Entity type:Organization
Organization Name:ATLANTIC LITHOTRIPSY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-983-7337
Mailing Address - Street 1:100 BRICK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2146
Mailing Address - Country:US
Mailing Address - Phone:856-983-7337
Mailing Address - Fax:856-983-6970
Practice Address - Street 1:100 BRICK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-983-7337
Practice Address - Fax:856-983-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ80185261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078922Medicare ID - Type Unspecified