Provider Demographics
NPI:1245247311
Name:JACKMAN, ALEXIS HOPE (MD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:HOPE
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:3020 WESTCHESTER AVENUE - SUITE 303
Practice Address - Street 2:ENT AND ALLERGY ASSOCIATES LLP
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2525
Practice Address - Country:US
Practice Address - Phone:914-607-6501
Practice Address - Fax:914-251-0868
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD429170207Y00000X
NY229023207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400109538Medicare PIN