Basic Information
Provider Information | |||||||||
NPI: | 1811337686 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALLEVA | ||||||||
FirstName: | ALDO | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 36 SKILLMAN AVE | ||||||||
Address2: |   | ||||||||
City: | BROOKLYN | ||||||||
State: | NY | ||||||||
PostalCode: | 112112204 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7183892382 | ||||||||
FaxNumber: | 7183890747 | ||||||||
Practice Location | |||||||||
Address1: | 101 ST. ANDREWS LANE | ||||||||
Address2: | NSLIJ-GLEN COVE HOSPITAL | ||||||||
City: | GLEN COVE | ||||||||
State: | NY | ||||||||
PostalCode: | 11542 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5166747631 | ||||||||
FaxNumber: | 5166747639 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/26/2013 | ||||||||
LastUpdateDate: | 05/31/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2854131 | NY | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.