Healthcare Provider Details

I. General information

NPI: 1356120711
Provider Name (Legal Business Name): ALEXANDER MFUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W MOSHOLU PKWY S APT 19G
BRONX NY
10468-1135
US

IV. Provider business mailing address

20 W MOSHOLU PKWY S APT 19G
BRONX NY
10468-1135
US

V. Phone/Fax

Practice location:
  • Phone: 347-854-4844
  • Fax:
Mailing address:
  • Phone: 347-854-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number585252
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number585252
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number585252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: