Provider Demographics
NPI:1821031303
Name:ALTMAN, ALISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:ALTMAN
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 1:180 E PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1915
Mailing Address - Country:US
Mailing Address - Phone:631-425-2110
Mailing Address - Fax:631-425-2133
Practice Address - Street 1:180 E PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1915
Practice Address - Country:US
Practice Address - Phone:631-425-2110
Practice Address - Fax:631-425-2133
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6B4311OtherEMPIRE BC.BS
NY7715242OtherAETNA
NY02151086Medicaid
NYH35184Medicare UPIN
NY6B4322Medicare PIN