Individual
ALEXANDER IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 BRIGHTWATER CT, BROOKLYN, NY 11235-7652
(718) 975-7690
(718) 975-7690
Mailing address
178 WATER ST, PERTH AMBOY, NJ 08861-4703
(718) 975-7690
(718) 975-7692
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
205206
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01842337
—
NY
Enumeration date
02/07/2007
Last updated
07/21/2022
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