Provider Demographics
NPI:1700978681
Name:ALEXIS, AMA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMA
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W 111TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1961
Mailing Address - Country:US
Mailing Address - Phone:917-442-6011
Mailing Address - Fax:405-638-3271
Practice Address - Street 1:49 MURRAY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2250
Practice Address - Country:US
Practice Address - Phone:212-729-1283
Practice Address - Fax:866-419-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241074207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02805049Medicaid
NY1417218991OtherGROUP NPI