Healthcare Provider Details

I. General information

NPI: 1750764007
Provider Name (Legal Business Name): ALEXANDER GUMBS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 04/05/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 STUART DR
SYOSSET NY
11791-5123
US

IV. Provider business mailing address

47 STUART DR
SYOSSET NY
11791-5123
US

V. Phone/Fax

Practice location:
  • Phone: 718-501-7859
  • Fax:
Mailing address:
  • Phone: 718-501-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402677
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339743
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: