Provider Demographics
NPI:1801694112
Name:ALEXANDER, ALEXIS EDEN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:EDEN
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FITZGERALD CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4423
Mailing Address - Country:US
Mailing Address - Phone:845-505-2530
Mailing Address - Fax:
Practice Address - Street 1:22 FITZGERALD CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4423
Practice Address - Country:US
Practice Address - Phone:845-505-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter