Provider Demographics
NPI:1013971704
Name:CHERVINSKY, ALEXANDER B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:B
Last Name:CHERVINSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5204
Mailing Address - Country:US
Mailing Address - Phone:718-630-8600
Mailing Address - Fax:718-630-8615
Practice Address - Street 1:8714 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5204
Practice Address - Country:US
Practice Address - Phone:718-630-8600
Practice Address - Fax:718-630-8615
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2772103G00000X, 103TC0700X
NY012825103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01727100Medicaid
NY01727100Medicaid
NYV90041Medicare PIN