Provider Demographics
NPI:1346379609
Name:YOZAWITZ, ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:YOZAWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ERIE BLVD E
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1144
Mailing Address - Country:US
Mailing Address - Phone:315-472-7947
Mailing Address - Fax:315-422-5535
Practice Address - Street 1:1101 ERIE BLVD E
Practice Address - Street 2:SUITE 207
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1144
Practice Address - Country:US
Practice Address - Phone:315-472-7947
Practice Address - Fax:315-422-5535
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006139103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39738BMedicare UPIN