MEDICARE: ALEX FREITAS PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F404256-01	NY

General Provider Information

NPI Number	:	1306561824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX FREITAS PMHNP-BC

Provider Business Mailing Address
First Line	:	158 W 75TH ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-1928
Country	:	US
Telephone Number	:	512-997-8775
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 W 75TH ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-1928
Country	:	US
Telephone Number	:	512-997-8775
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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