Provider Demographics
NPI:1912724386
Name:ARNOLD, ALEXANDRA SUSAN
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:SUSAN
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ORANGE BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-5059
Mailing Address - Country:US
Mailing Address - Phone:845-325-3329
Mailing Address - Fax:
Practice Address - Street 1:384 CRYSTAL RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4072
Practice Address - Country:US
Practice Address - Phone:845-769-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1193702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist