Provider Demographics
NPI:1578611893
Name:GERAZOUNIS, ALEXANDRA (MSLAC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GERAZOUNIS
Suffix:
Gender:F
Credentials:MSLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 FRANKLIN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2921
Mailing Address - Country:US
Mailing Address - Phone:516-742-1033
Mailing Address - Fax:
Practice Address - Street 1:975 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2921
Practice Address - Country:US
Practice Address - Phone:516-742-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002644-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist