Healthcare Provider Details

I. General information

NPI: 1497142343
Provider Name (Legal Business Name): ALEXANDRA EWENCZYK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HIGHLAND BLVD STE 2200
BOZEMAN MT
59715-6915
US

IV. Provider business mailing address

4802 10TH AVENUE MAIMONIDES MEDICAL CENTER
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMED-PHYS-LIC-131689
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: