Provider Demographics
NPI:1003193319
Name:ALEXIS HUGELMEYER, D.O., P.C.
Entity Type:Organization
Organization Name:ALEXIS HUGELMEYER, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-761-2500
Mailing Address - Street 1:35 W ALFRED AVE
Mailing Address - Street 2:
Mailing Address - City:BAITING HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1383
Mailing Address - Country:US
Mailing Address - Phone:516-761-2500
Mailing Address - Fax:631-591-3900
Practice Address - Street 1:1272 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2583
Practice Address - Country:US
Practice Address - Phone:516-761-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty