Provider Demographics
NPI:1639199193
Name:ALEXANDER Y. NEMIROVSKY, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALEXANDER Y. NEMIROVSKY, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMIROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-800-2437
Mailing Address - Street 1:PO BOX 4331
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90309-4331
Mailing Address - Country:US
Mailing Address - Phone:424-800-2437
Mailing Address - Fax:310-303-7944
Practice Address - Street 1:44301 LORIMER AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3700
Practice Address - Country:US
Practice Address - Phone:661-940-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76455207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A764550OtherBLUE SHIELD
CA00A764550Medicaid
CA00A764550Medicaid