Provider Demographics
NPI:1013932235
Name:NUDELMAN, ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:NUDELMAN
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 1:20 SQUADRON BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5200
Mailing Address - Country:US
Mailing Address - Phone:845-639-4630
Mailing Address - Fax:845-639-4630
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:#470
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5258
Practice Address - Country:US
Practice Address - Phone:845-639-4630
Practice Address - Fax:845-639-4630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00879130Medicaid
NYAN0V243610OtherBCBS
NYV24361Medicare PIN