Healthcare Provider Details

I. General information

NPI: 1104106244
Provider Name (Legal Business Name): ALEXANDER KUCHEROV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2011
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE STE 200
NORWALK CT
06851-1080
US

IV. Provider business mailing address

17 DERBY LN
OSSINING NY
10562-2702
US

V. Phone/Fax

Practice location:
  • Phone: 203-750-7400
  • Fax:
Mailing address:
  • Phone: 845-705-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number67246
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number280223
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number280223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: