Healthcare Provider Details

I. General information

NPI: 1194328682
Provider Name (Legal Business Name): ALEXANDRA MARIE CIPOLLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MERRICK AVE
EAST MEADOW NY
11554-4748
US

IV. Provider business mailing address

1983 MARCUS AVE STE 119
NEW HYDE PARK NY
11042-1016
US

V. Phone/Fax

Practice location:
  • Phone: 516-393-8900
  • Fax:
Mailing address:
  • Phone: 516-321-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046103-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: