Provider Demographics
NPI:1184167439
Name:TERBUSH, ALEXANDER LEE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEE
Last Name:TERBUSH
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 1:2 DELAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1202
Mailing Address - Country:US
Mailing Address - Phone:845-297-4789
Mailing Address - Fax:845-297-8596
Practice Address - Street 1:4353 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-3604
Practice Address - Country:US
Practice Address - Phone:845-233-4960
Practice Address - Fax:845-233-4961
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040701-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist