MEDICARE: ALEKSEY ETINGER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25MB11857000	NJ
2	207RN0300X	Nephrology Physician	280493	NY
3	208M00000X	Hospitalist Physician	5671140	ID
4	208M00000X	Hospitalist Physician	280493	NY

General Provider Information

NPI Number	:	1225304496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSEY ETINGER D.O.

Provider Business Mailing Address
First Line	:	8713 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7847
Country	:	US
Telephone Number	:	718-971-9509
Fax Number	:	718-971-1698

Provider Business Practice Location Address
First Line	:	8713 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7847
Country	:	US
Telephone Number	:	718-971-9509
Fax Number	:	718-971-1698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2012
Last Update Date	:	07/28/2025

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