Provider Demographics
NPI:1497943963
Name:PRESTIA, ALAN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EDWARD
Last Name:PRESTIA
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 1:39 SNOWDANCE LANE
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1572
Mailing Address - Country:US
Mailing Address - Phone:631-724-0654
Mailing Address - Fax:
Practice Address - Street 1:39 SNOWDANCE LANE
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1572
Practice Address - Country:US
Practice Address - Phone:631-724-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101410207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology