Healthcare Provider Details

I. General information

NPI: 1366680225
Provider Name (Legal Business Name): MR. ALEXANDER J. POSILKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 RICHMOND AVE
STATEN ISLAND NY
10314-5857
US

IV. Provider business mailing address

582 VANDERBILT AVE #4
BROOKLYN NY
11238-3527
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-6982
  • Fax: 718-982-6916
Mailing address:
  • Phone: 732-718-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: