Provider Demographics
NPI:1316935141
Name:LILEIKA, ALEXANDER
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:LILEIKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RADISSON PLZ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5766
Mailing Address - Country:US
Mailing Address - Phone:914-632-1100
Mailing Address - Fax:
Practice Address - Street 1:1 RADISSON PLZ
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5766
Practice Address - Country:US
Practice Address - Phone:914-632-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0172651174400000X
NY017265-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133733650OtherNR TAX IDENTIFICATION #
NY133586197OtherTAX IDENTIFICATION #
NY133733650OtherNRPT TAX ID #
NYP40321Medicare UPIN
NYQL6601Medicare ID - Type UnspecifiedMEDICARE #