NPIMap

Organization Active NPI

Atlantic Diagnostic Laboratories, LLC

  • Clinical Medical Laboratory
  • Mercer, PA
National Provider Identifier
1225424294
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
39D2069737 Issued in PA
Legal business name
ATLANTIC DIAGNOSTIC LABORATORIES, LLC
Practice address
8419 Sharon Mercer Rd
Mercer, PA 16137-3169
Phone
(724) 685-1376
NPI assigned
Apr 7, 2015
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Aaron Domenico
Title
Coo
Phone
(267) 525-2470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 39D2069737 PA Primary

Addresses

Primary practice location

8419 Sharon Mercer Rd
Mercer, PA 16137-3169

Mailing address

3520 Progress Dr Ste C
Bensalem, PA 19020-5810
Phone (866) 465-6763

Other identifiers 1

IdentifierTypeStateIssuer
1030010040001MedicaidPA

Other names 1

  • Innovative Laboratory Services Inc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Atlantic Diagnostics Laboratories3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1225424294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 PROGRESS DR STE C",
            "city": "BENSALEM",
            "state": "PA",
            "postal_code": "190205810",
            "telephone_number": "866-465-6763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8419 SHARON MERCER RD",
            "city": "MERCER",
            "state": "PA",
            "postal_code": "161373169",
            "telephone_number": "724-685-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC DIAGNOSTIC LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "DOMENICO",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "267-525-2470"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "39D2069737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030010040001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Laboratory Services Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mercer, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.