Healthcare Provider Details

I. General information

NPI: 1326074501
Provider Name (Legal Business Name): ALEXANDER SHUKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAIN ST ANESTHESIA DEPARTMENT
BAY SHORE NY
11706-8408
US

IV. Provider business mailing address

PO BOX 29140 SOUTH BAY ANESTHESIA
NEW YORK NY
10087-9140
US

V. Phone/Fax

Practice location:
  • Phone: 631-968-3163
  • Fax:
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number168442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: