=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548104482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLAS LIFESPAN, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 HARMONY LN
-----------------------------------------------------
City | MONMOUTH JUNCTION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08852-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-291-1480
-----------------------------------------------------
Fax | 631-291-1480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 HARMONY LN
-----------------------------------------------------
City | MONMOUTH JUNCTION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08852-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-291-1480
-----------------------------------------------------
Fax | 631-291-1480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. DEEP BHUPENDRA TRIVEDI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-291-1480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------