Healthcare Provider Details

I. General information

NPI: 1619268307
Provider Name (Legal Business Name): FAKHRY Y ALEXANDER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9719 LEFFERTS BLVD
SOUTH RICHMOND HILL NY
11419-1235
US

IV. Provider business mailing address

9719 LEFFERTS BLVD
SOUTH RICHMOND HILL NY
11419-1235
US

V. Phone/Fax

Practice location:
  • Phone: 718-846-1900
  • Fax: 718-441-9347
Mailing address:
  • Phone: 718-846-1900
  • Fax: 718-441-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number135193
License Number StateNY

VIII. Authorized Official

Name: FAKHRY Y ALEXANDER
Title or Position: OWNER, DOCTOR
Credential: M.D.
Phone: 718-846-1900