Provider Demographics
NPI:1316486566
Name:ATLAS DIAGNOSTIC HOLDINGS
Entity type:Organization
Organization Name:ATLAS DIAGNOSTIC HOLDINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHESKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-468-7480
Mailing Address - Street 1:4023 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1017
Mailing Address - Country:US
Mailing Address - Phone:813-443-2185
Mailing Address - Fax:813-443-4838
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9712
Practice Address - Country:US
Practice Address - Phone:718-789-1818
Practice Address - Fax:718-789-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC12300291U00000X
335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1799AMedicare PIN