Healthcare Provider Details

I. General information

NPI: 1760483655
Provider Name (Legal Business Name): NANETTE LAURIE ALEXANDER-THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 LINDEN BLVD
BROOKLYN NY
11212-2438
US

IV. Provider business mailing address

1 BROOKDALE PLZ STE 200
BROOKLYN NY
11212-3198
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5071
  • Fax:
Mailing address:
  • Phone: 718-240-7143
  • Fax: 718-240-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number173779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: