Provider Demographics
NPI:1184713232
Name:BRANDALISE, ALICIA RITA (MD)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:RITA
Last Name:BRANDALISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:87 08 JUSTICE AVE
Mailing Address - Street 2:1F
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-476-8900
Mailing Address - Fax:718-779-1583
Practice Address - Street 1:87 08 JUSTICE AVE
Practice Address - Street 2:1F
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4576
Practice Address - Country:US
Practice Address - Phone:718-476-8900
Practice Address - Fax:718-779-1583
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY137494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
37708Medicare ID - Type Unspecified
B14299Medicare UPIN