Atlantic Diagnostics Laboratories

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

024997 Issued in PA

Legal business name

ATLANTIC DIAGNOSTICS LABORATORIES

Practice address

1570 Garrett Rd
Upper Darby, PA 19082-4500

Phone

(215) 858-8801

NPI assigned

Jan 22, 2009

Organization subpart

Yes

Parent organization

ATLANTIC DIAGNOSTICS LABORATORIESAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paschal B Dejohn

Title

President

Phone

(215) 858-8801

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Atlantic Diagnostic Laboratories, LLC.

  • Clinical Medical Laboratory
  • Bensalem, PA
  • NPI 1881841120

  O20080922000375

  Same enrollment

Part of

Atlantic Diagnostics Laboratories

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1164660643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190824500",
            "telephone_number": "215-858-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190824500",
            "telephone_number": "215-858-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC DIAGNOSTICS LABORATORIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLANTIC DIAGNOSTICS LABORATORIES",
        "enumeration_date": "2009-01-22",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "DEJOHN",
        "authorized_official_first_name": "PASCHAL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-858-8801",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "024997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
• Clinical Medical Laboratory in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.