Doctor Name: | ALEXANDRA MARIE CARDELLO |
NPI Number: | 1518358811 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 018422 |
Business Practice Address: | 2835 Middle Country Rd Lake Grove, NY - 117552105 |
Business Phone Number: | 6314673564 |
Business Fax Number: | 6314712236 |
Mailing Address: | 11 Wilson Pl, LINDENHURST |
State: | NY |
Postal Code: | 117575935 |
Phone Number: | 6315606666 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2015 |
NPI Last Update Date: | 07/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 018422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |