Healthcare Provider Details

I. General information

NPI: 1295100774
Provider Name (Legal Business Name): ALEX SCHUTT MOMPREMIER A.N.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

7901 BROADWAY
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-4000
  • Fax:
Mailing address:
  • Phone: 718-334-4000
  • Fax: 718-334-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: