Healthcare Provider Details

I. General information

NPI: 1588527444
Provider Name (Legal Business Name): ALEXANDRA HOPE KLUKOSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

IV. Provider business mailing address

183 WOODLAND AVE
WESTWOOD NJ
07675-3218
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax:
Mailing address:
  • Phone: 201-899-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN10674-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: