Healthcare Provider Details

I. General information

NPI: 1083688667
Provider Name (Legal Business Name): JONELLE M N BINGHAM-ALEXANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WATERSIDE PROFESSIONAL PARK
PUTNAM VALLEY NY
10579-3505
US

IV. Provider business mailing address

50 DAYTON LN SUITE 202
PEEKSKILL NY
10566-2859
US

V. Phone/Fax

Practice location:
  • Phone: 914-528-7664
  • Fax: 914-526-2386
Mailing address:
  • Phone: 914-739-0087
  • Fax: 914-737-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number230893-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2013-0417
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: