Provider Demographics
NPI:1063922680
Name:ATHENAS, GARRETT JAMES (MS, CNS)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:JAMES
Last Name:ATHENAS
Suffix:
Gender:M
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3240
Mailing Address - Country:US
Mailing Address - Phone:631-629-9501
Mailing Address - Fax:
Practice Address - Street 1:68 E 22ND ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3240
Practice Address - Country:US
Practice Address - Phone:631-629-9501
Practice Address - Fax:631-629-9501
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
NY133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist