Provider Demographics
NPI:1376723494
Name:ISRAELI, ALEXANDER V (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:V
Last Name:ISRAELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 GRAND AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1525
Mailing Address - Country:US
Mailing Address - Phone:718-507-2077
Mailing Address - Fax:718-507-1031
Practice Address - Street 1:7215 GRAND AVE
Practice Address - Street 2:UNIT A
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1525
Practice Address - Country:US
Practice Address - Phone:718-507-2077
Practice Address - Fax:718-507-1031
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225588208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05444Medicare PIN
NYH72437Medicare UPIN