Provider Demographics
NPI:1841002839
Name:FLETE FREDERIQUE, ALEXANDRA (MT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:FLETE FREDERIQUE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MRS
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:FLETE-FREDERIQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT,PT
Mailing Address - Street 1:29 LOOKER ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2818
Mailing Address - Country:US
Mailing Address - Phone:908-967-1499
Mailing Address - Fax:
Practice Address - Street 1:179 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1510
Practice Address - Country:US
Practice Address - Phone:908-967-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01518900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist