Provider Demographics
NPI:1396000881
Name:DAVIS, ALEXANDRA THOMPSON
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:THOMPSON
Last Name:DAVIS
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 1:2287 JOHNSON AVE
Mailing Address - Street 2:7F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6400
Mailing Address - Country:US
Mailing Address - Phone:845-570-1488
Mailing Address - Fax:
Practice Address - Street 1:2287 JOHNSON AVE APT 7F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6412
Practice Address - Country:US
Practice Address - Phone:845-570-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist