Healthcare Provider Details

I. General information

NPI: 1689663742
Provider Name (Legal Business Name): ALEXANDER TRAKHTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 48TH ST
BROOKLYN NY
11219-2918
US

IV. Provider business mailing address

920 48TH ST
BROOKLYN NY
11219-2918
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7800
  • Fax: 718-635-7147
Mailing address:
  • Phone: 718-283-7800
  • Fax: 718-635-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number214889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: