Healthcare Provider Details

I. General information

NPI: 1457711103
Provider Name (Legal Business Name): MR. RICHARD ALENZE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WEST KINGBRIDGE ROAD DEPARTMENT OF VETERAN AFFAIRS, VA MEDICAL CENTER
BRONX NY
10468-3627
US

IV. Provider business mailing address

692 SAINT MARKS AVE APT 4B
BROOKLYN NY
11216-3627
US

V. Phone/Fax

Practice location:
  • Phone: 171-858-4900
  • Fax: 718-741-4615
Mailing address:
  • Phone: 347-569-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number017621-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: