Healthcare Provider Details

I. General information

NPI: 1659054831
Provider Name (Legal Business Name): ALEXANDRA STANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JERSEY AVE UNIT 16
EAST SETAUKET NY
11733-2036
US

IV. Provider business mailing address

900 MERCHANTS CONCOURSE STE 216
WESTBURY NY
11590-5114
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-6400
  • Fax:
Mailing address:
  • Phone: 516-226-8373
  • Fax: 516-226-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberF352426-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: