Provider Demographics
NPI:1780210427
Name:NEJATI, ALEXIS CORINE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CORINE
Last Name:NEJATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-3009
Mailing Address - Country:US
Mailing Address - Phone:315-382-8952
Mailing Address - Fax:
Practice Address - Street 1:15 TURNER LANE
Practice Address - Street 2:
Practice Address - City:EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13335
Practice Address - Country:US
Practice Address - Phone:607-965-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine