Provider Demographics
NPI:1841627197
Name:ATLAS, REBECCA MAE (MPH, MS)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MAE
Last Name:ATLAS
Suffix:
Gender:F
Credentials:MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 79TH ST
Mailing Address - Street 2:14R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6212
Mailing Address - Country:US
Mailing Address - Phone:973-865-4482
Mailing Address - Fax:
Practice Address - Street 1:200 W 79TH ST
Practice Address - Street 2:14 R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6212
Practice Address - Country:US
Practice Address - Phone:973-865-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY024572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1841627197Medicaid