Provider Demographics
NPI:1205968310
Name:VISCO, ALEXANDER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:VISCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MONROE ST STE E304
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6352
Mailing Address - Country:US
Mailing Address - Phone:201-533-9200
Mailing Address - Fax:
Practice Address - Street 1:720 MONROE ST STE E304
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6352
Practice Address - Country:US
Practice Address - Phone:201-533-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231025-32081S0010X
NJ25MA07808900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine