Healthcare Provider Details

I. General information

NPI: 1861911257
Provider Name (Legal Business Name): ALEXANDRA RUTH MANN-WEINER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 09/11/2026
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

IV. Provider business mailing address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-9140
  • Fax:
Mailing address:
  • Phone: 718-822-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: