Provider Demographics
NPI:1831787209
Name:SAROUSI, ALEXANDER B (LPN)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:B
Last Name:SAROUSI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 REGINA RD
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-4523
Mailing Address - Country:US
Mailing Address - Phone:508-397-1620
Mailing Address - Fax:
Practice Address - Street 1:17 REGINA RD
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-4523
Practice Address - Country:US
Practice Address - Phone:508-397-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY871347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse