Provider Demographics
NPI:1851342786
Name:ALEXIADES, MACRENE RENEE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MACRENE
Middle Name:RENEE
Last Name:ALEXIADES
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:DR
Other - First Name:MACRENE
Other - Middle Name:RENEE
Other - Last Name:ALEXIADES-ARMENAKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:955 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0321
Mailing Address - Country:US
Mailing Address - Phone:212-570-6800
Mailing Address - Fax:212-732-5762
Practice Address - Street 1:955 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0321
Practice Address - Country:US
Practice Address - Phone:212-570-6800
Practice Address - Fax:212-732-5762
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42885207N00000X
NY212414207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K3901Medicare ID - Type UnspecifiedMEDICARE ID
NYH40294Medicare UPIN