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General NPI Number Information
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NPI Number | 1851990642
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Entity Type | Organization
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Legal Business Name | ALEXA MEDICAL PC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 1135 MAIN AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2353
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Country | US
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Telephone | 973-988-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 539 ATLANTIC AVE # 12
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City | BROOKLYN
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State | NY
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Zip | 11217-1913
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Country | US
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Telephone | 973-988-1499
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | USAMA KHAYYAL
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Credential | MD
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Telephone | 973-988-1499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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