Provider Demographics
NPI:1023104023
Name:NICOLAIDES, ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:NICOLAIDES
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 1:2318 31ST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2892
Mailing Address - Country:US
Mailing Address - Phone:718-728-9822
Mailing Address - Fax:718-728-2004
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:SUITE 320
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-728-9822
Practice Address - Fax:718-728-2004
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212075207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07365GOtherMEDICARE PROVIDER NUMBER
NYH37269Medicare UPIN