Physician Compare National (NPI:1861563652)

HEALTHCARE PROVIDER: ALEXIS BISANGWA M.D

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1861563652
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3072592955
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040714001599
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BISANGWA
	Individual professional last name
Provider First Name	ALEXIS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC PSYCHIATRY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC PSYCHIATRY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	14709 ELM AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	B4
	Group Practice or individual's line 2 address
City	FLUSHING
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	113551705
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7184540735
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M