Provider Demographics
NPI:1093019556
Name:DALE ALEXANDER, D.O. P.C.
Entity Type:Organization
Organization Name:DALE ALEXANDER, D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-304-5901
Mailing Address - Street 1:292 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5400
Mailing Address - Country:US
Mailing Address - Phone:516-304-5901
Mailing Address - Fax:516-502-4492
Practice Address - Street 1:292 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5400
Practice Address - Country:US
Practice Address - Phone:516-304-5901
Practice Address - Fax:516-502-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229782173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI10810Medicare UPIN