Healthcare Provider Details

I. General information

NPI: 1093774580
Provider Name (Legal Business Name): LILIANA ALEXA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

475 SEAVIEW AVE
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-4133
  • Fax: 718-226-4185
Mailing address:
  • Phone: 718-226-4133
  • Fax: 718-226-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number226091-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: