Provider Demographics
NPI:1861960031
Name:ALECTINE, BERTINE SYLVIE
Entity type:Individual
Prefix:MISS
First Name:BERTINE
Middle Name:SYLVIE
Last Name:ALECTINE
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 1:108 - 18 QUEENS BLVD.
Mailing Address - Street 2:5TH FLOOR, SUITE 4A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:212-804-7659
Mailing Address - Fax:888-975-7704
Practice Address - Street 1:108-18 QUEENS BLVD
Practice Address - Street 2:5TH FLOOR, SUITE 4A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:888-975-7704
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145624071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist