Provider Demographics
NPI:1184644502
Name:GEORGE ALEXIADES, M.D. PC
Entity Type:Organization
Organization Name:GEORGE ALEXIADES, M.D. PC
Other - Org Name:GEORGE ALEXIADES MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-979-4200
Mailing Address - Street 1:380 2ND AVE
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5615
Mailing Address - Country:US
Mailing Address - Phone:646-438-7823
Mailing Address - Fax:646-438-7876
Practice Address - Street 1:310 E 14TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4486
Practice Address - Fax:212-979-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH49674Medicare UPIN