Healthcare Provider Details

I. General information

NPI: 1114235637
Provider Name (Legal Business Name): ALEXANDRA M LAMOTHE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GAZZOLA DR
E PATCHOGUE NY
11772-4900
US

IV. Provider business mailing address

1574 AUGUST RD
NORTH BABYLON NY
11703-1933
US

V. Phone/Fax

Practice location:
  • Phone: 631-447-8800
  • Fax:
Mailing address:
  • Phone: 631-804-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336182-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: