Provider Demographics
NPI:1245962745
Name:ALEXANDRIA PODIATRY CLINIC
Entity type:Organization
Organization Name:ALEXANDRIA PODIATRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-324-2441
Mailing Address - Street 1:252 CEDRUS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4515
Mailing Address - Country:US
Mailing Address - Phone:347-324-2441
Mailing Address - Fax:
Practice Address - Street 1:1281 PADDINGTON RD
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3257
Practice Address - Country:US
Practice Address - Phone:347-324-2441
Practice Address - Fax:718-310-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty