Provider Demographics
NPI:1760420772
Name:FALKOVSKY, ALEXANDER A
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:A
Last Name:FALKOVSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E MERRICK RD
Mailing Address - Street 2:STE 306
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 E MERRICK RD
Practice Address - Street 2:STE 306
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5800
Practice Address - Country:US
Practice Address - Phone:516-872-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01769066Medicaid
NY02V34Medicare ID - Type Unspecified
NY01769066Medicaid