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General NPI Number Information
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NPI Number | 1750524823
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Entity Type | Individual
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Provider Name | EDWARD ALEXANDER SI
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Gender | Male
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Dates
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Enumeration Date | 04/19/2009
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Last Update Date | 04/19/2009
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Provider Practice Location Address
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Address Line | 1662 OCEAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-4905
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Country | US
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Telephone | 718-677-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 510 BRIGHTON BEACH AVE APT.208
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City | BROOKLYN
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State | NY
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Zip | 11235-6404
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Country | US
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Telephone | 917-916-1322
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 21883
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License Number State | NY
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