Healthcare Provider Details

I. General information

NPI: 1013225853
Provider Name (Legal Business Name): ALAN SUPRANER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NETHERLAND AVE 108
BRONX NY
10463-4801
US

IV. Provider business mailing address

2600 NETHERLAND AVE SUITE 108
BRONX NY
10463-4801
US

V. Phone/Fax

Practice location:
  • Phone: 718-601-7227
  • Fax:
Mailing address:
  • Phone: 718-601-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number010827
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010827
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number010827
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number010827
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number010827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: