Provider Demographics
NPI:1013561240
Name:MOSKALUK, ALEXANDRA LARA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:LARA
Last Name:MOSKALUK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 77TH STREET BROOKLYN, NY 11209
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-836-2063
Mailing Address - Fax:
Practice Address - Street 1:522 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3003
Practice Address - Country:US
Practice Address - Phone:929-226-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001922176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife