Provider Demographics
NPI:1447249602
Name:MINARDI, ALEXANDER F (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:F
Last Name:MINARDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 VILLAGE CIR S
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-9649
Mailing Address - Country:US
Mailing Address - Phone:631-874-0094
Mailing Address - Fax:
Practice Address - Street 1:55 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2133
Practice Address - Country:US
Practice Address - Phone:631-277-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08253-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM8961Medicare ID - Type Unspecified