Provider Demographics
NPI:1376274753
Name:INKOOM, ALEXANDER PROPERMAN
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PROPERMAN
Last Name:INKOOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 ALCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1218
Mailing Address - Country:US
Mailing Address - Phone:267-239-1168
Mailing Address - Fax:
Practice Address - Street 1:534 ALCOTT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1218
Practice Address - Country:US
Practice Address - Phone:267-239-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst