Provider Demographics
NPI:1881556157
Name:ATLANTIC HEALTH SOURCE INC
Entity type:Organization
Organization Name:ATLANTIC HEALTH SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEYNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-400-5582
Mailing Address - Street 1:313 STATE ST UNIT 513
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4128
Mailing Address - Country:US
Mailing Address - Phone:973-400-5582
Mailing Address - Fax:
Practice Address - Street 1:313 STATE ST UNIT 513
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4128
Practice Address - Country:US
Practice Address - Phone:973-400-5582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies