Provider Demographics
NPI:1952391245
Name:TEPPER, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:TEPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E END AVE
Mailing Address - Street 2:9E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7831
Mailing Address - Country:US
Mailing Address - Phone:212-828-0900
Mailing Address - Fax:212-876-4461
Practice Address - Street 1:65 E 96TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0730
Practice Address - Country:US
Practice Address - Phone:212-828-0900
Practice Address - Fax:212-828-5360
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206045174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG49914Medicare UPIN