Provider Demographics
NPI:1942237433
Name:KLAT, ALAN (PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:KLAT
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 1:10 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1117
Mailing Address - Country:US
Mailing Address - Phone:516-868-3421
Mailing Address - Fax:516-623-3644
Practice Address - Street 1:FAR ROCKAWAY NURSING HOME
Practice Address - Street 2:13-11 VIRGINIA ST.
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-327-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00391286Medicaid
NY35059 16HOtherGHI ID #
NYV17881Medicare ID - Type UnspecifiedBCBS MEDICARE ID