Provider Demographics
NPI:1235751967
Name:ZAJAC, ALEXANDER EDWARD JOSEPH
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:EDWARD JOSEPH
Last Name:ZAJAC
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 1:3959 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-342-8600
Mailing Address - Fax:212-342-8598
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-342-8600
Practice Address - Fax:212-342-8598
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY755499163W00000X
NY350502363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY350502OtherNEW YORK NURSE PRACTITIONER - NEONATOLOGY