Provider Demographics
NPI:1295174621
Name:ALEXANDRE, ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SAINT JAMES PL
Mailing Address - Street 2:3BL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1241
Mailing Address - Country:US
Mailing Address - Phone:760-447-2180
Mailing Address - Fax:
Practice Address - Street 1:64 SAINT JAMES PL
Practice Address - Street 2:3BL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1241
Practice Address - Country:US
Practice Address - Phone:760-447-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005066-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist