Provider Demographics
NPI:1457020943
Name:ALEXANDRE, LOU W (PA)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:W
Last Name:ALEXANDRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68A NEWARK WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3310
Mailing Address - Country:US
Mailing Address - Phone:305-332-1403
Mailing Address - Fax:
Practice Address - Street 1:60 EVERGREEN PL STE 400
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2120
Practice Address - Country:US
Practice Address - Phone:973-395-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00640200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty