Individual
DR. ALEXANDER JORG WALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
13223 79TH ST, OZONE PARK, NY 11417-1137
(718) 456-5600
Mailing address
PO BOX 211261, WOODHAVEN, NY 11421
(718) 456-5600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
162148
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01345073
—
NY
01
—
04310
MEDICARE ID
NY
Enumeration date
07/12/2006
Last updated
01/04/2021
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