Basic Information
| Provider Information | |||||||||
| NPI: | 1336770973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALYSON R PIDICH MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800A 5TH AVE STE 205 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100657215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127583200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800A 5TH AVE STE 205 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100657215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127583200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2020 | ||||||||
| LastUpdateDate: | 02/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | PIDICH | ||||||||
| AuthorizedOfficialFirstName: | ALYSON | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2127583200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.