Provider Demographics
NPI:1902977093
Name:GUTMAN, ALYSON (MD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:F
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:LIJ DEV. & BEHAV. PEDIATRICS
Mailing Address - Street 2:1983 MARCUS AVENUE
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-802-6100
Mailing Address - Fax:
Practice Address - Street 1:LIJ DEV. & BEHAV. PEDIATRICS
Practice Address - Street 2:1983 MARCUS AVENUE
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-802-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1834782080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics