Provider Demographics
NPI:1255663001
Name:NANETTE ALEXANDER-THOMAS MD
Entity Type:Organization
Organization Name:NANETTE ALEXANDER-THOMAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:ALEXANDER-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-727-0020
Mailing Address - Street 1:682 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2507
Mailing Address - Country:US
Mailing Address - Phone:718-727-0020
Mailing Address - Fax:718-876-1393
Practice Address - Street 1:682 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2507
Practice Address - Country:US
Practice Address - Phone:718-727-0020
Practice Address - Fax:718-876-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173779261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08F412Medicare UPIN