Provider Demographics
NPI:1083869929
Name:ELLYN ALTMAN, PHD, PC
Entity Type:Organization
Organization Name:ELLYN ALTMAN, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-829-5034
Mailing Address - Street 1:57 OLD POND RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1029
Mailing Address - Country:US
Mailing Address - Phone:516-829-5034
Mailing Address - Fax:516-487-3899
Practice Address - Street 1:57 OLD POND RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1029
Practice Address - Country:US
Practice Address - Phone:516-829-5034
Practice Address - Fax:516-487-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty