MEDICARE: DR. ALVIN B PITKOW PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	007081	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	055771	OTHER	NY	VALUE OPTIONS
2	0022078	OTHER	NY	GHI

General Provider Information

NPI Number	:	1790833390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN B PITKOW PHD

Provider Business Mailing Address
First Line	:	PO BOX 314
Second Line	:
City	:	OLD WESTBURY
State	:	NY
Zip	:	11568-0314
Country	:	US
Telephone Number	:	516-459-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	788 FRANKLIN AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1502
Country	:	US
Telephone Number	:	516-459-2990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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