Provider Demographics
NPI:1578826418
Name:FORMAN, ALEXA BETH (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:BETH
Last Name:FORMAN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:BETH
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:333 E. 38TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:516-672-1051
Mailing Address - Fax:
Practice Address - Street 1:333 E. 38TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:646-501-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily