Provider Demographics
NPI:1447220694
Name:KADISON, ALAN STUART (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:STUART
Last Name:KADISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-487-9454
Mailing Address - Fax:516-487-2745
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-487-9454
Practice Address - Fax:516-487-2745
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02395031Medicaid
NYH52557Medicare UPIN
NY02395031Medicaid