Provider Demographics
NPI:1457711103
Name:ALENZE, RICHARD JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:ALENZE
Suffix:JR
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 1:692 SAINT MARKS AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3627
Mailing Address - Country:US
Mailing Address - Phone:347-569-1103
Mailing Address - Fax:
Practice Address - Street 1:130 WEST KINGBRIDGE ROAD
Practice Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS, VA MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3627
Practice Address - Country:US
Practice Address - Phone:171-858-4900
Practice Address - Fax:718-741-4615
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017621-1246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory