Provider Demographics
NPI:1548508674
Name:GUTTENPLAN, ALYS
Entity type:Individual
Prefix:
First Name:ALYS
Middle Name:
Last Name:GUTTENPLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 5TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2636
Mailing Address - Country:US
Mailing Address - Phone:191-720-4937
Mailing Address - Fax:
Practice Address - Street 1:460 5TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2636
Practice Address - Country:US
Practice Address - Phone:917-204-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00105600171100000X
NY004442171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004442OtherACUPUNCTURE LICENSE