Provider Demographics
NPI:1033155775
Name:CORDIANO, ALEXIS (MD)
Entity Type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:
Last Name:CORDIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:MARIE
Other - Last Name:CORDIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:197 HARDENBURG RD
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5346
Mailing Address - Country:US
Mailing Address - Phone:845-658-8434
Mailing Address - Fax:845-658-8432
Practice Address - Street 1:45 READE PLACE
Practice Address - Street 2:VASSAR BROTHERS MEDICAL CENTER
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-431-5624
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235687207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02700916Medicaid
NY1512Q1Medicare ID - Type Unspecified
NY02700916Medicaid