Healthcare Provider Details

I. General information

NPI: 1447249602
Provider Name (Legal Business Name): ALEXANDER F MINARDI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CARLETON AVE
EAST ISLIP NY
11730-2133
US

IV. Provider business mailing address

25 VILLAGE CIR S
MANORVILLE NY
11949-9649
US

V. Phone/Fax

Practice location:
  • Phone: 631-277-2341
  • Fax:
Mailing address:
  • Phone: 631-874-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number08253-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: