Provider Demographics
NPI:1063500155
Name:ATHAN, STEPHEN S (CH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:ATHAN
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5640
Mailing Address - Country:US
Mailing Address - Phone:516-334-7000
Mailing Address - Fax:516-334-7082
Practice Address - Street 1:1065 OLD COUNTRY RD
Practice Address - Street 2:SUITE 214
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5640
Practice Address - Country:US
Practice Address - Phone:516-334-7000
Practice Address - Fax:516-334-7082
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08423OtherWORKERS' COMPENSATION
NYC08423OtherWORKERS' COMPENSATION
NYU66075Medicare UPIN