Healthcare Provider Details

I. General information

NPI: 1689761264
Provider Name (Legal Business Name): ALEXANDER SHAKNOVICH, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 61ST ST 4TH FLOOR
NEW YORK NY
10021-8722
US

IV. Provider business mailing address

425 E 61ST ST 4TH FLOOR
NEW YORK NY
10021-8722
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-2900
  • Fax:
Mailing address:
  • Phone: 212-752-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number159030
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER SHAKNOVICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-752-2900