Provider Demographics
NPI:1487870234
Name:DIMICH, ALEXANDRA B (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:B
Last Name:DIMICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:B
Other - Last Name:BAISHANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 E 79TH ST
Mailing Address - Street 2:SUITE 20E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0830
Mailing Address - Country:US
Mailing Address - Phone:212-734-8232
Mailing Address - Fax:
Practice Address - Street 1:201 E 79TH ST
Practice Address - Street 2:SUITE 20E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0830
Practice Address - Country:US
Practice Address - Phone:212-734-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104505207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78591Medicare UPIN