Provider Demographics
NPI:1780750299
Name:KANEVSKY, ALEXANDER M (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:KANEVSKY
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 1:2370 YORK RD
Mailing Address - Street 2:SUITE D4
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1031
Mailing Address - Country:US
Mailing Address - Phone:215-491-9900
Mailing Address - Fax:215-491-9902
Practice Address - Street 1:2370 YORK RD
Practice Address - Street 2:SUITE D4
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1031
Practice Address - Country:US
Practice Address - Phone:215-491-9900
Practice Address - Fax:215-491-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0365802084P0800X
NJ25MA083982002084P0800X, 207Q00000X
PAMD4300632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G55939Medicare UPIN
CT260003446Medicare ID - Type Unspecified