Healthcare Provider Details

I. General information

NPI: 1851342786
Provider Name (Legal Business Name): MACRENE RENEE ALEXIADES MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MACRENE RENEE ALEXIADES-ARMENAKAS MD PHD

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 PARK AVE
NEW YORK NY
10028-0321
US

IV. Provider business mailing address

955 PARK AVE
NEW YORK NY
10028-0321
US

V. Phone/Fax

Practice location:
  • Phone: 212-570-6800
  • Fax: 212-732-5762
Mailing address:
  • Phone: 212-570-6800
  • Fax: 212-732-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number42885
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number212414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: