Healthcare Provider Details

I. General information

NPI: 1619811684
Provider Name (Legal Business Name): ADAM MICHAEL ATLAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3511
US

IV. Provider business mailing address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3511
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-6111
  • Fax:
Mailing address:
  • Phone: 516-822-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: