Healthcare Provider Details

I. General information

NPI: 1548104482
Provider Name (Legal Business Name): ATLAS LIFESPAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HARMONY LN
MONMOUTH JUNCTION NJ
08852-2815
US

IV. Provider business mailing address

16 HARMONY LN
MONMOUTH JUNCTION NJ
08852-2815
US

V. Phone/Fax

Practice location:
  • Phone: 631-291-1480
  • Fax: 631-291-1480
Mailing address:
  • Phone: 631-291-1480
  • Fax: 631-291-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEP BHUPENDRA TRIVEDI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 631-291-1480