Healthcare Provider Details

I. General information

NPI: 1285634352
Provider Name (Legal Business Name): IAN ATLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 JAMES ST SUITE 3A
MORRISTOWN NJ
07960-6392
US

IV. Provider business mailing address

PO BOX 912
WHIPPANY NJ
07981-0912
US

V. Phone/Fax

Practice location:
  • Phone: 973-206-8282
  • Fax: 973-599-1695
Mailing address:
  • Phone: 973-206-8282
  • Fax: 973-599-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMA58005
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: