Provider Demographics
NPI:1700419041
Name:FLECKER, ALEXANDER SOROKIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SOROKIN
Last Name:FLECKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1121
Mailing Address - Country:US
Mailing Address - Phone:716-326-4678
Mailing Address - Fax:
Practice Address - Street 1:138 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1121
Practice Address - Country:US
Practice Address - Phone:716-326-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1170747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant