Healthcare Provider Details

I. General information

NPI: 1255187993
Provider Name (Legal Business Name): ALEXIA KAFKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EASTDALE AVE N
POUGHKEEPSIE NY
12603-1694
US

IV. Provider business mailing address

50 EASTDALE AVE N
POUGHKEEPSIE NY
12603-1694
US

V. Phone/Fax

Practice location:
  • Phone: 845-437-5000
  • Fax:
Mailing address:
  • Phone: 845-437-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: