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General NPI Number Information
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NPI Number | 1770583163
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Entity Type | Individual
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Provider Name | ALEXANDER IVANOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 465 UNION AVE
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-3196
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Country | US
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Telephone | 908-722-6410
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Fax | 908-722-4638
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Provider Business Mailing Address
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Address Line | 465 UNION AVE
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-3196
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Country | US
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Telephone | 908-722-6410
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Fax | 908-722-4638
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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 | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 25MA073897
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License Number State | NJ
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