Provider Demographics
NPI:1710058896
Name:IOSPA, ALLA (MD)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:IOSPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SURF AVENUE, APT. 17 L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:646-662-2200
Mailing Address - Fax:
Practice Address - Street 1:28 W 44TH ST
Practice Address - Street 2:SUITE 812
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7406
Practice Address - Country:US
Practice Address - Phone:646-383-7575
Practice Address - Fax:646-706-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2289932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551224Medicaid
NYP3645543OtherOXFORD HEALTH PLANS
NY0007414771OtherAETNA
NY1213364OtherCIGNA BEHAVIORAL HEALTH
NY228993OtherHIP
NY441BA1Medicare ID - Type Unspecified
NY0007414771OtherAETNA