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General NPI Number Information
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NPI Number | 1720419625
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Entity Type | Organization
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Legal Business Name | ALEXANDRA & ETHAN, INC.
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 385 FIFTH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 212-510-8601
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Fax | 212-510-8634
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Provider Business Mailing Address
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Address Line | 385 FIFTH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 212-510-8601
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Fax | 212-510-8634
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Authorized Official
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Title or Position | PRESIDENT
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Name | INESSA ILYAYEVA
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Credential | OD
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Telephone | 212-510-8601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 009263-1
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License Number State | NY
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