Provider Demographics
NPI:1336361385
Name:VIDAL, ALEX (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:VIDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:VIDAL-GUEVARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1916 UNION BLVD.
Mailing Address - Street 2:DEPARTMENT OF CARDIOLOGY
Mailing Address - City:BAYSHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-666-2290
Mailing Address - Fax:631-647-8068
Practice Address - Street 1:1916 UNION BLVD.
Practice Address - Street 2:DEPARTMENT OF CARDIOLOGY
Practice Address - City:BAYSHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-666-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252831207RA0002X, 207RC0001X, 207RH0005X, 207UN0902X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03112470Medicaid
NY1336361385OtherNPI