Healthcare Provider Details

I. General information

NPI: 1437788833
Provider Name (Legal Business Name): ALEXANDRA AMEDEA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 40TH ST RM 801
NEW YORK NY
10016-1801
US

IV. Provider business mailing address

770 MIDDLE NECK RD
GREAT NECK NY
11024-1956
US

V. Phone/Fax

Practice location:
  • Phone: 212-725-0123
  • Fax: 212-725-6065
Mailing address:
  • Phone: 212-725-0123
  • Fax: 212-725-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number339258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: