Healthcare Provider Details

I. General information

NPI: 1538530357
Provider Name (Legal Business Name): PAULETTE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 WHITE PLAINS RD
BRONX NY
10467-8124
US

IV. Provider business mailing address

3050 WHITE PLAINS RD
BRONX NY
10467-8124
US

V. Phone/Fax

Practice location:
  • Phone: 718-944-7003
  • Fax: 718-944-7090
Mailing address:
  • Phone: 718-944-7003
  • Fax: 718-944-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number000499-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: