Provider Demographics
NPI:1528116266
Name:ALEXA MEDICAL SUPPLY
Entity type:Organization
Organization Name:ALEXA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-484-2175
Mailing Address - Street 1:308 W MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2617
Mailing Address - Country:US
Mailing Address - Phone:631-484-2175
Mailing Address - Fax:
Practice Address - Street 1:308 W MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2617
Practice Address - Country:US
Practice Address - Phone:631-484-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4197910001Medicare ID - Type Unspecified