Provider Demographics
NPI:1831397033
Name:PERESTAM, ALAN REED (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:REED
Last Name:PERESTAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159B MCMASTER ST
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1336
Mailing Address - Country:US
Mailing Address - Phone:607-687-0800
Mailing Address - Fax:607-687-3942
Practice Address - Street 1:159B MCMASTER ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1336
Practice Address - Country:US
Practice Address - Phone:607-687-0800
Practice Address - Fax:607-687-3942
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005926-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB3336Medicare PIN
NYU09804Medicare UPIN