Provider Demographics
NPI:1902964414
Name:JOSEPH ALESSANDRO
Entity Type:Organization
Organization Name:JOSEPH ALESSANDRO
Other - Org Name:BROOKLYN FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-779-5940
Mailing Address - Street 1:63 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-1901
Mailing Address - Country:US
Mailing Address - Phone:860-779-5940
Mailing Address - Fax:860-779-5499
Practice Address - Street 1:63 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1901
Practice Address - Country:US
Practice Address - Phone:860-779-5940
Practice Address - Fax:860-779-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02893Medicare ID - Type UnspecifiedMEDICARE GROUP #