Provider Demographics
NPI:1932274156
Name:ETKIN, ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:ETKIN
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 1:1302 KINGS HWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1960
Mailing Address - Country:US
Mailing Address - Phone:718-645-2700
Mailing Address - Fax:718-645-3188
Practice Address - Street 1:1302 KINGS HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1960
Practice Address - Country:US
Practice Address - Phone:718-645-2700
Practice Address - Fax:718-645-3188
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY211343OtherHIP
NYAE0346AS10OtherBLUE CROSS BLUE SHIELD
NY1861640OtherUNITED HEALTHCARE
NY5460762OtherAETNA
NY2589491OtherGHI
NY01863890Medicaid
NYP1309519OtherOXFORD HEALTH PLAN
NYV243OtherHEALTH PLUS
NY2589491OtherGHI
NY211343OtherHIP