Provider Demographics
NPI:1821249731
Name:TAPPER, ALEC G
Entity Type:Individual
Prefix:MR
First Name:ALEC
Middle Name:G
Last Name:TAPPER
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 1:639 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2005
Mailing Address - Country:US
Mailing Address - Phone:917-365-3722
Mailing Address - Fax:
Practice Address - Street 1:639 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2005
Practice Address - Country:US
Practice Address - Phone:917-365-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293171-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse