1801850003 NPI number — ALEXANDER PINKUSOVICH MD

Table of content: ALEXANDER PINKUSOVICH MD (NPI 1801850003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801850003 NPI number — ALEXANDER PINKUSOVICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINKUSOVICH
Provider First Name:
ALEXANDER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801850003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2965 OCEAN PKWY
Provider Second Line Business Mailing Address:
STE 5A
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-8024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-680-1600
Provider Business Mailing Address Fax Number:
718-680-4473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2965 OCEAN PKWY STE 5A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-8024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-680-1600
Provider Business Practice Location Address Fax Number:
718-680-4473
Provider Enumeration Date:
04/14/2006

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: 2084P0800X , with the licence number:  205917 , 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)

  • Identifier: 2004609 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9134307 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11-3552139 . This is a "1199 NBF" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P886909 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01717582 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87M431 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11-3552139 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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