Provider Demographics
NPI:1356769129
Name:ATKINS, STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:ATKINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PROSPECT ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3382
Mailing Address - Country:US
Mailing Address - Phone:631-470-2499
Mailing Address - Fax:631-368-8143
Practice Address - Street 1:75 PROSPECT ST
Practice Address - Street 2:SUITE 114
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3382
Practice Address - Country:US
Practice Address - Phone:631-470-2499
Practice Address - Fax:631-368-8143
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist