Provider Demographics
NPI:1275670705
Name:ALATRISTE, MICHAEL ANTHONY (MLDT-CLT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ALATRISTE
Suffix:
Gender:M
Credentials:MLDT-CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:124 GROVE AVE UNIT 86
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-4004
Mailing Address - Country:US
Mailing Address - Phone:212-691-0330
Mailing Address - Fax:212-691-0880
Practice Address - Street 1:153 W 27TH ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0399
Practice Address - Country:US
Practice Address - Phone:212-691-0330
Practice Address - Fax:212-691-0880
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist