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General NPI Number Information
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NPI Number | 1528791258
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Entity Type | Organization
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Legal Business Name | ALTA PSYCHIATRY PLLC
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Dates
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Enumeration Date | 07/09/2022
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 18 E 41ST ST FL 14
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City | NEW YORK
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State | NY
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Zip | 10017-6244
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Country | US
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Telephone | 929-260-2084
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 58TH ST APT 3G
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City | NEW YORK
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State | NY
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Zip | 10022-2333
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Country | US
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Telephone | 984-244-4926
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTIAN BJERRE REAL
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Credential | MD
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Telephone | 984-244-4926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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