Healthcare Provider Details

I. General information

NPI: 1851159388
Provider Name (Legal Business Name): ATLAS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 8TH AVE
BROOKLYN NY
11220-3516
US

IV. Provider business mailing address

5504 8TH AVE
BROOKLYN NY
11220-3516
US

V. Phone/Fax

Practice location:
  • Phone: 917-353-9717
  • Fax: 347-812-0486
Mailing address:
  • Phone: 917-353-9717
  • Fax: 347-812-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KOK TIMMY LANG
Title or Position: DIRECTOR
Credential:
Phone: 917-353-9717