Provider Demographics
NPI:1043275050
Name:DELVENTHAL, ALICE K (CNM)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:K
Last Name:DELVENTHAL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CORNELIA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2779
Mailing Address - Country:US
Mailing Address - Phone:518-562-7777
Mailing Address - Fax:518-562-7707
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-562-7777
Practice Address - Fax:518-562-7707
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000052-1176B00000X
NYF4207721363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02737933Medicaid
NYJ400020433OtherMEDICARE PTAN