Healthcare Provider Details

I. General information

NPI: 1194211979
Provider Name (Legal Business Name): ALEJANDRO GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEJANDRO GUTIERREZ MD

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-5400
US

IV. Provider business mailing address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6501
  • Fax: 516-572-5609
Mailing address:
  • Phone: 516-572-6501
  • Fax: 516-572-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME157854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: