Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 008516-1 | NY |
NPI | 1104913961 |
---|---|
Provider Name | Dr. Gregory Alexander |
First Address | Stony Brook, NY 11790-2404 |
Second Address | Bay Shore, NY 11706-8322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |