Provider Demographics
NPI:1184725152
Name:KABIRI, ALEXANDER JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:KABIRI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 OLD PALISADE RD
Mailing Address - Street 2:# 3415
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7064
Mailing Address - Country:US
Mailing Address - Phone:646-831-1715
Mailing Address - Fax:718-217-6101
Practice Address - Street 1:8787 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2867
Practice Address - Country:US
Practice Address - Phone:718-465-4999
Practice Address - Fax:718-217-6101
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02586143Medicaid