Healthcare Provider Details

I. General information

NPI: 1871656751
Provider Name (Legal Business Name): ALAN S ELLIOT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MADISON AVE SUITE 1400
NEW YORK NY
10016-5110
US

IV. Provider business mailing address

171 MADISON AVE SUITE 1400
NEW YORK NY
10016-5110
US

V. Phone/Fax

Practice location:
  • Phone: 212-243-2304
  • Fax: 914-834-0366
Mailing address:
  • Phone: 212-243-2304
  • Fax: 914-834-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011514
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number011514
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number011514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: