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General NPI Number Information
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NPI Number | 1992526289
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Entity Type | Individual
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Provider Name | ALVIN NICHOLAS PHD
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Gender | Male
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 32 UNION SQ E
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City | NEW YORK
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State | NY
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Zip | 10003-3209
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Country | US
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Telephone | 917-916-9052
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Fax |
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Provider Business Mailing Address
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Address Line | 7637 JERICHO TPKE
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City | WOODBURY
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State | NY
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Zip | 11797-1701
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Country | US
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Telephone | 248-259-7184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P131396
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License Number State | NY
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