Provider Demographics
NPI:1225224579
Name:GIMPELEVICH, ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:GIMPELEVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 40TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0113
Mailing Address - Country:US
Mailing Address - Phone:212-684-4325
Mailing Address - Fax:
Practice Address - Street 1:16 E 40TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0113
Practice Address - Country:US
Practice Address - Phone:212-684-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243377208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY243377OtherLICENSE