Basic Information
| Provider Information | |||||||||
| NPI: | 1669824132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALATEVI | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 HARRIS BUSHVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HARRIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453338909 | ||||||||
| FaxNumber: | 8457961404 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 HARRIS BUSHVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HARRIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453338909 | ||||||||
| FaxNumber: | 8457961404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 315006 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 07106687 | 05 | NY | MEDICAID |