Provider Demographics
NPI:1790738417
Name:DE LA CHAPELLE, ALAIN
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:DE LA CHAPELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 EAST 72ND STREET
Mailing Address - Street 2:APT 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-879-8962
Mailing Address - Fax:212-988-6789
Practice Address - Street 1:530 EAST 72ND STREET
Practice Address - Street 2:APT 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-879-8962
Practice Address - Fax:212-988-6789
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1104882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00197526Medicaid
NY70451100Medicare ID - Type Unspecified