Provider Demographics
NPI:1770544009
Name:LESSOW, ALEXA S (MD)
Entity type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:S
Last Name:LESSOW
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 1:1049 5TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0115
Mailing Address - Country:US
Mailing Address - Phone:212-861-1961
Mailing Address - Fax:212-861-0561
Practice Address - Street 1:1049 5TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0115
Practice Address - Country:US
Practice Address - Phone:212-861-1961
Practice Address - Fax:212-861-0561
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219325207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I03116Medicare UPIN
NY7M5111Medicare ID - Type Unspecified