Healthcare Provider Details

I. General information

NPI: 1912956301
Provider Name (Legal Business Name): ROBERT ALEXANDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 N BROADWAY
MASSAPEQUA NY
11758-2328
US

IV. Provider business mailing address

850 HICKSVILLE RD STE 104
SEAFORD NY
11783-1300
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: