MEDICARE: DR. ALEXANDRA YUNGELSON DDS

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	1223G0001X	General Practice Dentistry	22DI02470300	NJ
2	1223G0001X	General Practice Dentistry	010512	CT
3	1223G0001X	General Practice Dentistry	055740	NY

General Provider Information

NPI Number	:	1720371222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA YUNGELSON DDS

Provider Business Mailing Address
First Line	:	200 W 15TH ST UNIT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-6658
Country	:	US
Telephone Number	:	212-201-0766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 E 28TH ST
Second Line	:	APARTMENT 3F
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2453
Country	:	US
Telephone Number	:	516-852-5386
Fax Number	:

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

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	10/08/2019

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