Provider Demographics
NPI:1427368497
Name:NESTERENKO, ALEXANDER (RPN)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:NESTERENKO
Suffix:
Gender:M
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 E 19TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4657
Mailing Address - Country:US
Mailing Address - Phone:347-328-3472
Mailing Address - Fax:
Practice Address - Street 1:198 FOSTER AVE
Practice Address - Street 2:SUITES C&D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2133
Practice Address - Country:US
Practice Address - Phone:718-666-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627475-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse