Healthcare Provider Details

I. General information

NPI: 1154142610
Provider Name (Legal Business Name): ALEXANDRA ANNE CIMIERI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 LITTLE EAST NECK RD
WEST BABYLON NY
11704-2411
US

IV. Provider business mailing address

385 GRAND AVE
LINDENHURST NY
11757-3922
US

V. Phone/Fax

Practice location:
  • Phone: 631-671-0274
  • Fax:
Mailing address:
  • Phone: 631-671-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: