Provider Demographics
NPI:1881863447
Name:ALEXANDRE B. DE MOURA MD PC
Entity Type:Organization
Organization Name:ALEXANDRE B. DE MOURA MD PC
Other - Org Name:NEW YORK SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDRE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DE MOURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-357-8777
Mailing Address - Street 1:761 MERRICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-9996
Mailing Address - Country:US
Mailing Address - Phone:516-357-8777
Mailing Address - Fax:516-357-7251
Practice Address - Street 1:761 MERRICK AVENUE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-9996
Practice Address - Country:US
Practice Address - Phone:516-357-8777
Practice Address - Fax:516-357-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1994051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty