Healthcare Provider Details

I. General information

NPI: 1275189375
Provider Name (Legal Business Name): ATN PHYSICIANS & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 12/19/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CHURCHMANS RD STE 103
NEWARK DE
19702-1945
US

IV. Provider business mailing address

115 CETON CT
BROOMALL PA
19008-2500
US

V. Phone/Fax

Practice location:
  • Phone: 877-286-5115
  • Fax: 866-286-4935
Mailing address:
  • Phone: 484-535-1231
  • Fax: 866-286-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ATHOS R CERRATO
Title or Position: CMO
Credential: DO
Phone: 484-535-1231