Healthcare Provider Details

I. General information

NPI: 1114500352
Provider Name (Legal Business Name): ALEXA ANN EYRING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1551
US

IV. Provider business mailing address

402 CHESTNUT AVE
EAST MEADOW NY
11554-2850
US

V. Phone/Fax

Practice location:
  • Phone: 516-739-7733
  • Fax:
Mailing address:
  • Phone: 516-458-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10903501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: