1568743888 NPI number — MS. ALEXANDRA MINDY MARISE BIALKE MA, OTR/L

Table of content: SONIA CARIDAD SCHNEIDER LMHC (NPI 1174905491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568743888 NPI number — MS. ALEXANDRA MINDY MARISE BIALKE MA, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIALKE
Provider First Name:
ALEXANDRA MINDY
Provider Middle Name:
MARISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOOTH
Provider Other First Name:
ALEXANDRA MINDY
Provider Other Middle Name:
MARISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, OTR/L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568743888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 DOANSBURG RD
Provider Second Line Business Mailing Address:
BOX 719, GREEN CHIMNEYS
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10509-5902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-279-2995
Provider Business Mailing Address Fax Number:
845-279-3077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 DOANSBURG RD
Provider Second Line Business Practice Location Address:
BOX 719, GREEN CHIMNEYS
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10509-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-279-2995
Provider Business Practice Location Address Fax Number:
845-279-3077
Provider Enumeration Date:
08/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  016702-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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