Provider Demographics
NPI:1497181788
Name:SMOTRITSKIY, ALEXANDRA (TEACHER)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SMOTRITSKIY
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BEACH 144TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1119
Mailing Address - Country:US
Mailing Address - Phone:718-928-8524
Mailing Address - Fax:
Practice Address - Street 1:406 BEACH 144TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11694-1119
Practice Address - Country:US
Practice Address - Phone:718-928-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3542784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist