Provider Demographics
NPI:1023065653
Name:MACALLISTER, WILLIAM S (PHD)
Entity type:Individual
Prefix:PROF
First Name:WILLIAM
Middle Name:S
Last Name:MACALLISTER
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 1:223 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4852
Mailing Address - Country:US
Mailing Address - Phone:646-558-0809
Mailing Address - Fax:
Practice Address - Street 1:223 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4852
Practice Address - Country:US
Practice Address - Phone:646-558-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015665103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596770Medicaid
NY02596770Medicaid
NYQ33598Medicare UPIN