Healthcare Provider Details

I. General information

NPI: 1083440168
Provider Name (Legal Business Name): ALEXANDRA NICOLE VROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FAIR ST
CARMEL NY
10512-1398
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 100
TARRYTOWN NY
10591-5172
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-8441
  • Fax:
Mailing address:
  • Phone: 914-874-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: