Organization
ELISA/ACT BIOTECHNOLOGIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL MERRIT JAFFE MD (PRESIDENT/ CEO)
(703) 788-5111
Entity
Organization
Contact information
Practice address
14 PIDGEON HILL DR, SUITE 300, STERLING, VA 20165-6155
(703) 788-5101
(703) 450-2981
Mailing address
14 PIDGEON HILL DR, SUITE 300, STERLING, VA 20165-6155
(703) 788-5101
(703) 450-2981
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259195
BLUE CROSS BLUE SHIELD ID
VA
05
—
4995635
—
VA
Enumeration date
06/11/2006
Last updated
08/22/2020
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