1124211875 NPI number — ATLANTIC DERMATOPATHOLOGY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124211875 NPI number — ATLANTIC DERMATOPATHOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC DERMATOPATHOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124211875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-0523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-673-0423
Provider Business Mailing Address Fax Number:
866-865-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 INDUSTRIAL HIGHWAY
Provider Second Line Business Practice Location Address:
AIRPORT BUSINESS COMPLEX - Q3, SUITE 1
Provider Business Practice Location Address City Name:
LESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19029-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-521-5040
Provider Business Practice Location Address Fax Number:
610-521-5044
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMARO
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
610-521-5040

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  030360 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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