=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790987154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN L. CHISHOLM M. DIV.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 E 50TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-6804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-935-5023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 S BROADWAY
-----------------------------------------------------
City | NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10960-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-646-2339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 102L00000X
-----------------------------------------------------
Taxonomy Name | Psychoanalyst
-----------------------------------------------------
License Number | 000747-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------