Provider Demographics
NPI:1437305380
Name:MACRENE ALEXIADES MD PLLC
Entity Type:Organization
Organization Name:MACRENE ALEXIADES MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MACRENE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ALEXIADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:917-263-0961
Mailing Address - Street 1:955 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-570-2067
Mailing Address - Fax:
Practice Address - Street 1:955 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-570-2067
Practice Address - Fax:212-734-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212414207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty