Provider Demographics
NPI:1972694073
Name:ATLANTIC PATHOLOGY GROUP, PA
Entity type:Organization
Organization Name:ATLANTIC PATHOLOGY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REILOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-956-2986
Mailing Address - Street 1:1335 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3127
Mailing Address - Country:US
Mailing Address - Phone:321-956-2986
Mailing Address - Fax:321-956-9430
Practice Address - Street 1:1335 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3127
Practice Address - Country:US
Practice Address - Phone:321-956-2986
Practice Address - Fax:321-956-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21149357704 01OtherBEECHSTREET
FLP2498579OtherOXFORD HEALTH PLAN
FL1305501OtherBC/BS OF PA
FL34921OtherHARVARD PILGRAM
FL618277OtherTRIGON BC/BS
FL34921OtherHARVARD PILGRAM
FL=========OtherTAX ID NUMBER
FLP2498579OtherOXFORD HEALTH PLAN