Provider Demographics
NPI:1053675884
Name:ROSS, ALEXA LAUREN
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:LAUREN
Last Name:ROSS
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 1:90 SCHENCK AVE
Mailing Address - Street 2:1A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3643
Mailing Address - Country:US
Mailing Address - Phone:516-445-0056
Mailing Address - Fax:
Practice Address - Street 1:90 SCHENCK AVE
Practice Address - Street 2:1A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3643
Practice Address - Country:US
Practice Address - Phone:516-445-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist