Provider Demographics
NPI:1225288632
Name:HUGELMEYER, ALEXIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:HUGELMEYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:VENUTOLO-MANTOVANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6144 ROUTE 25A
Mailing Address - Street 2:BUILDING C, SUITE 13, BOX 10
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2018
Mailing Address - Country:US
Mailing Address - Phone:631-963-4760
Mailing Address - Fax:631-963-4761
Practice Address - Street 1:6144 ROUTE 25A
Practice Address - Street 2:BUILDING C, SUITE 13, BOX 10
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2018
Practice Address - Country:US
Practice Address - Phone:631-963-4760
Practice Address - Fax:631-963-4761
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine