Healthcare Provider Details

I. General information

NPI: 1386186880
Provider Name (Legal Business Name): ALEXANDRA LANGBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST PAYSON 695
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST # 695
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3978
  • Fax:
Mailing address:
  • Phone: 212-746-1723
  • Fax: 212-746-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340485-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: