Provider Demographics
NPI:1417997289
Name:ITENBERG, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:ITENBERG
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:PO BOX 3308
Mailing Address - Street 2:TROY ANESTHESIOLOGISTS, PC.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3308
Mailing Address - Country:US
Mailing Address - Phone:866-868-8419
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:100 HITCHCOCK WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4125
Practice Address - Country:US
Practice Address - Phone:603-695-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL164289207L00000X
NY159389-1207L00000X
NH15921207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00843834Medicaid
NY56454CMedicare ID - Type Unspecified
NY00843834Medicaid