MEDICARE: ATLAS LIFESPAN, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	202D00000X	Integrative Medicine Physician
2	208800000X	Urology Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548104482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS LIFESPAN, PC

Provider Business Mailing Address
First Line	:	16 HARMONY LN
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2815
Country	:	US
Telephone Number	:	631-291-1480
Fax Number	:	631-291-1480

Provider Business Practice Location Address
First Line	:	16 HARMONY LN
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2815
Country	:	US
Telephone Number	:	631-291-1480
Fax Number	:	631-291-1480

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DEEP BHUPENDRA TRIVEDI
Credential	:	MD
Telephone Number	:	631-291-1480

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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