Provider Demographics
NPI:1942317110
Name:DUSTMAN, ALAN VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:VINCENT
Last Name:DUSTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:ALAN
Other - Middle Name:VINCENT
Other - Last Name:BORRONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-742-0110
Mailing Address - Fax:516-746-4541
Practice Address - Street 1:103 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-742-0110
Practice Address - Fax:516-746-4541
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV25641Medicare ID - Type Unspecified