Provider Demographics
NPI:1104098946
Name:DIENSTAG, ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:DIENSTAG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WEST 238TH ST
Mailing Address - Street 2:4J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1846
Mailing Address - Country:US
Mailing Address - Phone:917-301-4622
Mailing Address - Fax:718-543-5204
Practice Address - Street 1:525 WEST 238TH ST
Practice Address - Street 2:4J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1846
Practice Address - Country:US
Practice Address - Phone:917-301-4622
Practice Address - Fax:718-543-5204
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical