Provider Demographics
NPI:1467010561
Name:GHADAMI, ALEXIS MONA
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MONA
Last Name:GHADAMI
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 1:64 SADDLE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2728
Mailing Address - Country:US
Mailing Address - Phone:516-661-7810
Mailing Address - Fax:516-354-4845
Practice Address - Street 1:1645 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5810
Practice Address - Country:US
Practice Address - Phone:718-579-2643
Practice Address - Fax:718-579-2644
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program