Provider Demographics
NPI:1871177915
Name:PUSHKANZER, ALEX (LNHA)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:PUSHKANZER
Suffix:
Gender:M
Credentials:LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 BRIGHTON 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6762
Mailing Address - Country:US
Mailing Address - Phone:718-891-4400
Mailing Address - Fax:718-484-1235
Practice Address - Street 1:2865 BRIGHTON 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6762
Practice Address - Country:US
Practice Address - Phone:718-891-4400
Practice Address - Fax:718-484-1235
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05875376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator