Provider Demographics
NPI:1992906432
Name:FUNICELLO, ALEX VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:VINCENT
Last Name:FUNICELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8060 SANCTUARY DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5998
Mailing Address - Country:US
Mailing Address - Phone:914-584-8257
Mailing Address - Fax:
Practice Address - Street 1:5996 SW 70TH ST FL 5
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3540
Practice Address - Country:US
Practice Address - Phone:305-284-7655
Practice Address - Fax:305-284-7763
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98852207Q00000X, 208600000X
NJ25MA098088002086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115914100Medicaid
NYA400002523Medicare PIN