Provider Demographics
NPI:1124443932
Name:FISCHER, ALEXANDRA (LMT, BCST)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:LMT, BCST
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, BCST
Mailing Address - Street 1:4141 46TH ST
Mailing Address - Street 2:APT. 3-O
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1869
Mailing Address - Country:US
Mailing Address - Phone:619-318-8866
Mailing Address - Fax:
Practice Address - Street 1:4141 46TH ST
Practice Address - Street 2:APT. 3-O
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1869
Practice Address - Country:US
Practice Address - Phone:619-318-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018959-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist