Provider Demographics
NPI:1053493635
Name:ALEXANDER, KEITH J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:J
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2079 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3415
Mailing Address - Country:US
Mailing Address - Phone:609-586-0444
Mailing Address - Fax:
Practice Address - Street 1:2079 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3415
Practice Address - Country:US
Practice Address - Phone:609-586-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2952103TC0700X
PAPS005462-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ736872NR7Medicare UPIN
NJ033855Medicare ID - Type UnspecifiedGROUP MEDICARE UPIN