Provider Demographics
NPI:1023347978
Name:ATLANTIC HEALTH
Entity type:Organization
Organization Name:ATLANTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, HR & CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KNACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-660-3125
Mailing Address - Street 1:120 DORSA AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-422-7984
Mailing Address - Fax:973-535-3920
Practice Address - Street 1:120 DORSA AVENUE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-422-7984
Practice Address - Fax:973-535-3920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy