Provider Demographics
NPI:1699775254
Name:GUTMAN, ALAN JAY (PA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JAY
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:91 CHENANGO BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1293
Mailing Address - Country:US
Mailing Address - Phone:607-648-4151
Mailing Address - Fax:607-648-7138
Practice Address - Street 1:91 CHENANGO BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1293
Practice Address - Country:US
Practice Address - Phone:607-648-4151
Practice Address - Fax:607-648-7138
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028443772Medicaid
NY028443772Medicaid
NYS64872Medicare UPIN