Provider Demographics
NPI:1265812515
Name:ALAN DITCHEK, M.D. PLLC
Entity type:Organization
Organization Name:ALAN DITCHEK, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DITCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-769-0444
Mailing Address - Street 1:2516 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3916
Mailing Address - Country:US
Mailing Address - Phone:718-769-0444
Mailing Address - Fax:718-769-5593
Practice Address - Street 1:2516 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3916
Practice Address - Country:US
Practice Address - Phone:718-769-0444
Practice Address - Fax:718-769-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty