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General NPI Number Information
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NPI Number | 1528719705
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Entity Type | Individual
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Provider Name | ALEXANDER KHISLAVSKY
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Gender | Male
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 249 GLENWOOD RD
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City | BINGHAMTON
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State | NY
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Zip | 13905-1603
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Country | US
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Telephone | 607-240-4901
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Fax |
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Provider Business Mailing Address
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Address Line | 249 GLENWOOD RD
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City | BINGHAMTON
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State | NY
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Zip | 13905-1603
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Country | US
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Telephone | 607-240-4901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025797
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1295
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License Number State | NM
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