Provider Demographics
NPI:1093857401
Name:ALEX, JOHN (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ALEX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 BUCKHORN ST
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1906
Mailing Address - Country:US
Mailing Address - Phone:845-309-5892
Mailing Address - Fax:
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist