Provider Demographics
NPI:1275728560
Name:ALEXANDER, DEEPU KOSHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPU
Middle Name:KOSHY
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:325 E MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3114
Mailing Address - Country:US
Mailing Address - Phone:631-654-3278
Mailing Address - Fax:631-654-1474
Practice Address - Street 1:325 E MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3114
Practice Address - Country:US
Practice Address - Phone:631-654-3278
Practice Address - Fax:631-654-1474
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245999207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03026400Medicaid
NY03026400Medicaid