Provider Demographics
NPI:1982742565
Name:LE GUILLOU, ALAIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAIN
Middle Name:A
Last Name:LE GUILLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 PALMER AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2483
Mailing Address - Country:US
Mailing Address - Phone:914-834-1590
Mailing Address - Fax:914-315-6225
Practice Address - Street 1:2039 PALMER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2483
Practice Address - Country:US
Practice Address - Phone:914-834-1590
Practice Address - Fax:914-315-6225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199443208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY199443OtherNY STATE LICENSE
NYBL4424038OtherDEA REGISTRATION
NY199443OtherNY STATE LICENSE