Provider Demographics
NPI:1386017747
Name:ATKINSON, MICHAEL KEVIN (NP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 HORSEBLOCK RD STE H
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-233-9490
Mailing Address - Fax:631-233-9499
Practice Address - Street 1:400 HORSEBLOCK RD STE H
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-233-9490
Practice Address - Fax:631-233-9499
Is Sole Proprietor?:No
Enumeration Date:2015-11-07
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY709050163W00000X
NY403162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse