Provider Demographics
NPI:1316924715
Name:SHEKHTER, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:SHEKHTER
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 1:3111 OCEAN PKWY
Mailing Address - Street 2:APT 7B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8400
Mailing Address - Country:US
Mailing Address - Phone:718-332-7916
Mailing Address - Fax:718-332-7918
Practice Address - Street 1:2965 OCEAN PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8014
Practice Address - Country:US
Practice Address - Phone:718-332-7916
Practice Address - Fax:718-332-7918
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4383493OtherECFMG NUMBER
NY01551431Medicaid
NY198143OtherSTATE LICENSE NUMBER
NYBS4334594OtherDEA REGISTRATION NUMBER
NY01551431Medicaid
NYG05864Medicare UPIN