Healthcare Provider Details

I. General information

NPI: 1811611841
Provider Name (Legal Business Name): ALEXIS MASSOUD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS KRASAS

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-373-6453
  • Fax:
Mailing address:
  • Phone: 201-833-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01378500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: