Provider Demographics
NPI:1265091573
Name:FREDAS, ALEXANDRA
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:FREDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1441
Mailing Address - Country:US
Mailing Address - Phone:516-322-5468
Mailing Address - Fax:
Practice Address - Street 1:644 VALLEY RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:NJ
Practice Address - Zip Code:07933-2012
Practice Address - Country:US
Practice Address - Phone:908-991-3761
Practice Address - Fax:908-991-3770
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01681900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist