MEDICARE: IRINA ALEKSEYEVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA07524800	NJ
2	207L00000X	Anesthesiology Physician	218480	NY

General Provider Information

NPI Number	:	1093719478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA ALEKSEYEVA M.D.

Provider Business Mailing Address
First Line	:	391 LINCOLN AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5045
Country	:	US
Telephone Number	:	917-650-8786
Fax Number	:

Provider Business Practice Location Address
First Line	:	391 LINCOLN AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5045
Country	:	US
Telephone Number	:	917-650-8786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/29/2013

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