Provider Demographics
NPI:1982132684
Name:TABAKIN, ALEXANDRA LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LAUREN
Last Name:TABAKIN
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 1:4 KNOLLWOOD TER
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3012
Mailing Address - Country:US
Mailing Address - Phone:862-812-7749
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 19
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08903-0019
Practice Address - Country:US
Practice Address - Phone:732-235-7674
Practice Address - Fax:732-235-8372
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program