Provider Demographics
NPI:1528791258
Name:ALTA PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ALTA PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BJERRE REAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:984-244-4926
Mailing Address - Street 1:400 E 58TH ST APT 3G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2333
Mailing Address - Country:US
Mailing Address - Phone:984-244-4926
Mailing Address - Fax:
Practice Address - Street 1:18 E 41ST ST FL 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6244
Practice Address - Country:US
Practice Address - Phone:929-260-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTA PSYCHIATRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-09
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty