Healthcare Provider Details

I. General information

NPI: 1093017972
Provider Name (Legal Business Name): ALEX KAZHDAN D.C., L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2010
Last Update Date: 11/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MEMPHIS AVE #1
STATEN ISLAND NY
10312-3401
US

IV. Provider business mailing address

43 MEMPHIS AVE #1
STATEN ISLAND NY
10312-3401
US

V. Phone/Fax

Practice location:
  • Phone: 646-552-0344
  • Fax:
Mailing address:
  • Phone: 646-552-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number70 011933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: