Provider Demographics
NPI:1720371222
Name:YUNGELSON, ALEXANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:YUNGELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 15TH ST UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6658
Mailing Address - Country:US
Mailing Address - Phone:212-201-0766
Mailing Address - Fax:
Practice Address - Street 1:2741 E 28TH ST
Practice Address - Street 2:APARTMENT 3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2453
Practice Address - Country:US
Practice Address - Phone:516-852-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024703001223G0001X
CT0105121223G0001X
NY0557401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice