Provider Demographics
NPI:1790833390
Name:PITKOW, ALVIN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:B
Last Name:PITKOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-0314
Mailing Address - Country:US
Mailing Address - Phone:516-459-2990
Mailing Address - Fax:
Practice Address - Street 1:788 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1502
Practice Address - Country:US
Practice Address - Phone:516-459-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055771OtherVALUE OPTIONS
NY0022078OtherGHI