1760463087 NPI number — ALEXANDRA DEMETRIOU OTR L CHT

Table of content: ALEXANDRA DEMETRIOU OTR L CHT (NPI 1760463087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760463087 NPI number — ALEXANDRA DEMETRIOU OTR L CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMETRIOU
Provider First Name:
ALEXANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR L CHT
Provider Gender Code:
F

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:
1760463087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 SUNRISE HWY
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-6027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-206-3130
Provider Business Mailing Address Fax Number:
631-206-3148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 SUNRISE HWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-206-3130
Provider Business Practice Location Address Fax Number:
631-206-3148
Provider Enumeration Date:
11/14/2005

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: 174400000X , with the licence number:  007141-1 , 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)

  • Identifier: 200424663 . This is a "TAX PAYER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com