Provider Demographics
NPI:1578246740
Name:ALEXANDRE, MIRIAM (MASTER DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:MASTER DEGREE
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:ALEXANDRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTER DEGREE
Mailing Address - Street 1:1589 PRESIDENT ST APT 11
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4754
Mailing Address - Country:US
Mailing Address - Phone:917-239-3042
Mailing Address - Fax:
Practice Address - Street 1:1312 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3612
Practice Address - Country:US
Practice Address - Phone:718-686-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1399742201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist