Provider Demographics
NPI:1700645132
Name:INCONTRO, ALEXANDRA ROSE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:INCONTRO
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 1:2589 FORTESQUE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2411
Mailing Address - Country:US
Mailing Address - Phone:516-524-3741
Mailing Address - Fax:
Practice Address - Street 1:1895 WALT WHITMAN RD STE 8
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3027
Practice Address - Country:US
Practice Address - Phone:631-577-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist