Healthcare Provider Details

I. General information

NPI: 1104913961
Provider Name (Legal Business Name): GREGORY ALEXANDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WEST MAIN ST. SUITE #9
BAY SHORE NY
11706-8322
US

IV. Provider business mailing address

40 MARION AVE.
STONY BROOK NY
11790-2404
US

V. Phone/Fax

Practice location:
  • Phone: 631-969-9792
  • Fax:
Mailing address:
  • Phone: 631-689-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number008516-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: