Provider Demographics
NPI:1245741883
Name:AUSTIN, ALEXIS R
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:R
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 FERRIS PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3611
Mailing Address - Country:US
Mailing Address - Phone:718-730-1004
Mailing Address - Fax:
Practice Address - Street 1:95 RAVINE AVE BLDG 13
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2163
Practice Address - Country:US
Practice Address - Phone:917-698-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator