Provider Demographics
NPI:1578732723
Name:GISTRAK, ALLAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
Last Name:GISTRAK
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 1:14 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580
Mailing Address - Country:US
Mailing Address - Phone:914-698-6764
Mailing Address - Fax:914-698-8454
Practice Address - Street 1:14 ANCHOR DR
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580
Practice Address - Country:US
Practice Address - Phone:914-698-6764
Practice Address - Fax:914-698-8454
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY835872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
185891Medicare PIN