Healthcare Provider Details

I. General information

NPI: 1265201875
Provider Name (Legal Business Name): ALEC MENGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 3RD AVE
BROOKLYN NY
11209-7717
US

IV. Provider business mailing address

9508 AVENUE L
BROOKLYN NY
11236-4811
US

V. Phone/Fax

Practice location:
  • Phone: 702-907-7171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026605-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: