Provider Demographics
NPI:1427603927
Name:ATANASSOV, ALEXANDER IAVOROV
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:IAVOROV
Last Name:ATANASSOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1345
Mailing Address - Country:US
Mailing Address - Phone:908-514-9635
Mailing Address - Fax:908-548-9250
Practice Address - Street 1:304 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1345
Practice Address - Country:US
Practice Address - Phone:908-514-9635
Practice Address - Fax:908-548-9250
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator