Provider Demographics
NPI:1205093770
Name:LYMPHEDEMA ALLIANCE OF NEW YORK
Entity type:Organization
Organization Name:LYMPHEDEMA ALLIANCE OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ALATRISTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CLT
Authorized Official - Phone:212-691-0330
Mailing Address - Street 1:448 WEST 57TH STREET
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-691-0330
Mailing Address - Fax:212-691-0880
Practice Address - Street 1:448 WEST 57TH STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-691-0330
Practice Address - Fax:212-691-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty