Healthcare Provider Details

I. General information

NPI: 1194253393
Provider Name (Legal Business Name): ALEXANDRA MORGAN BUETTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SCHOOL ST
RONKONKOMA NY
11779-2298
US

IV. Provider business mailing address

1152 GRUNDY AVE
HOLBROOK NY
11741-2633
US

V. Phone/Fax

Practice location:
  • Phone: 631-471-1700
  • Fax:
Mailing address:
  • Phone: 631-335-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: