Basic Information
| Provider Information | |||||||||
| NPI: | 1013971704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHERVINSKY | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8714 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112095204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186308600 | ||||||||
| FaxNumber: | 7186308615 | ||||||||
| Practice Location | |||||||||
| Address1: | 8714 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112095204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186308600 | ||||||||
| FaxNumber: | 7186308615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 2772 | MD | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | 012825 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 2772 | MD | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | 012825 | NY | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 01727100 | 05 | NY | MEDICAID |