Provider Demographics
NPI:1861706749
Name:EITEL, ALEXANDRA NICKELS
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:NICKELS
Last Name:EITEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 BROADWAY STE 214
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6825
Mailing Address - Country:US
Mailing Address - Phone:212-228-3521
Mailing Address - Fax:
Practice Address - Street 1:799 BROADWAY STE 214
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6825
Practice Address - Country:US
Practice Address - Phone:212-228-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY000969-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program