# ATLAS ORTHOSURGERY, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790057354
- **Authorized official:** DR. KENNETH MCCULLOCH MD (PRESIDENT)
- **Authorized official phone:** 12125881919

## Contact information

- **Practice address:** 333 E 56TH ST, NEW YORK, NY 10022-3758
- **Practice address phone:** (212) 588-1919
- **Mailing address:** 11616 QUEENS BLVD, SUITE 222, FOREST HILLS, NY 11375-7012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 01/29/2012
- **Last updated:** 01/29/2012