Provider Demographics
NPI:1922036946
Name:ATLANTIC PROFESSIONAL SERVICES OF RHODE ISLAND INCORPORATED
Entity Type:Organization
Organization Name:ATLANTIC PROFESSIONAL SERVICES OF RHODE ISLAND INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ISTVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-842-1900
Mailing Address - Street 1:PO BOX 635998
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 KENYON AVENUE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4299
Practice Address - Country:US
Practice Address - Phone:401-782-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDC9415OtherMEDICARE TRAVELERS RR - G
NY02821543Medicaid
RI7003615Medicaid
PA1018847630001Medicaid
RI7003615Medicaid
RIDC9415OtherMEDICARE TRAVELERS RR - G