Provider Demographics
NPI:1710026224
Name:RECINE, ALEXANDRA (MAOTR)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:RECINE
Suffix:
Gender:F
Credentials:MAOTR
Other - Prefix:MRS
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAOTR
Mailing Address - Street 1:40 SOUTH BAY AV E
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941
Mailing Address - Country:US
Mailing Address - Phone:631-325-8133
Mailing Address - Fax:631-325-8133
Practice Address - Street 1:691 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764
Practice Address - Country:US
Practice Address - Phone:631-821-7227
Practice Address - Fax:631-821-3588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005917-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005917-1OtherPROFESSIONAL LICENCE