Provider Demographics
NPI:1083688667
Name:BINGHAM-ALEXANDER, JONELLE M N (MD)
Entity Type:Individual
Prefix:
First Name:JONELLE
Middle Name:M N
Last Name:BINGHAM-ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DAYTON LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2859
Mailing Address - Country:US
Mailing Address - Phone:914-739-0087
Mailing Address - Fax:914-737-1714
Practice Address - Street 1:205 WATERSIDE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3505
Practice Address - Country:US
Practice Address - Phone:914-528-7664
Practice Address - Fax:914-526-2386
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230893-1207V00000X
NMMD2013-0417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02523111Medicaid
NYA400075824Medicare PIN
NYI06555Medicare UPIN