1942317110 NPI number — DR. ALAN VINCENT DUSTMAN PHD

Table of content: DR. ALAN VINCENT DUSTMAN PHD (NPI 1942317110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942317110 NPI number — DR. ALAN VINCENT DUSTMAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUSTMAN
Provider First Name:
ALAN
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORRONI
Provider Other First Name:
ALAN
Provider Other Middle Name:
VINCENT
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942317110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-742-0110
Provider Business Mailing Address Fax Number:
516-746-4541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-742-0110
Provider Business Practice Location Address Fax Number:
516-746-4541
Provider Enumeration Date:
08/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)