Basic Information
| Provider Information | |||||||||
| NPI: | 1265460604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHRAGA | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SRAGOVICH | ||||||||
| OtherFirstName: | ALEXANDER | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD, MPH | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 385 ROUTE 18 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323901883 | ||||||||
| FaxNumber: | 7329071711 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 ROUTE 18 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323901883 | ||||||||
| FaxNumber: | 7329071711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 11/12/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 25MA07491000 | NJ | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 227114 | NY | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2688539000 | 01 | NJ | AMERIHEALTH GROUP NUMBER | OTHER | 2255993000 | 01 | NJ | AMERIHEALTH INDIVIDUAL NO | OTHER | 1207739 | 01 | NJ | AETNA | OTHER |