Provider Demographics
NPI:1801850003
Name:PINKUSOVICH, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PINKUSOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 OCEAN PKWY
Mailing Address - Street 2:STE 5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8024
Mailing Address - Country:US
Mailing Address - Phone:718-680-1600
Mailing Address - Fax:718-680-4473
Practice Address - Street 1:2965 OCEAN PKWY STE 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8024
Practice Address - Country:US
Practice Address - Phone:718-680-1600
Practice Address - Fax:718-680-4473
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2059172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2004609OtherCIGNA
NY9134307OtherPHCS
NY11-3552139Other1199 NBF
NYP886909OtherOXFORD
NY01717582Medicaid
NY87M431OtherEMPIRE BC/BS
NY11-3552139OtherMAGNACARE
NY87M431OtherEMPIRE BC/BS
NYP886909OtherOXFORD