Provider Demographics
NPI:1306049952
Name:GRANITE, ALEXIS LEIBEL (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:LEIBEL
Last Name:GRANITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:CAMILLE
Other - Last Name:LEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:32 ERICSSON PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-374-9750
Mailing Address - Fax:212-374-9705
Practice Address - Street 1:32 ERICSSON PLACE
Practice Address - Street 2:TRIBECA PARK DERMATOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-374-9750
Practice Address - Fax:212-374-9705
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233213207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology