Provider Demographics
NPI:1659388437
Name:ALLISON J. BEITLER, MD, PLLC
Entity Type:Organization
Organization Name:ALLISON J. BEITLER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:JATLOW
Authorized Official - Last Name:BEITLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-794-1600
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M104
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-794-1600
Mailing Address - Fax:718-794-1222
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M104
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-794-1600
Practice Address - Fax:718-794-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497025Medicaid
NY01497025Medicaid