Healthcare Provider Details

I. General information

NPI: 1922036946
Provider Name (Legal Business Name): ATLANTIC PROFESSIONAL SERVICES OF RHODE ISLAND INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENYON AVENUE
WAKEFIELD RI
02879-4299
US

IV. Provider business mailing address

PO BOX 635998
CINCINNATI OH
45263-5998
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ISTVAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 518-842-1900