Individual
DR. ALEXIS BISANGWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4359 147TH ST, FLUSHING, NY 11355-1739
(718) 454-0735
(718) 454-0736
Mailing address
8920 LYMAN ST, QUEENS VILLAGE, NY 11428-1406
(917) 923-7091
(718) 454-0736
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
212769
NY
2084P0805X
Geriatric Psychiatry Physician
212769
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01996721
—
NY
01
—
526404
VALUE OPTIONS MHS NUMBER
NY
Enumeration date
11/13/2006
Last updated
11/09/2010
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