Basic Information
| Provider Information | |||||||||
| NPI: | 1275728560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | DEEPU | ||||||||
| MiddleName: | KOSHY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E MAIN ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117723114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316543278 | ||||||||
| FaxNumber: | 6316541474 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 E MAIN ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117723114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316543278 | ||||||||
| FaxNumber: | 6316541474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 245999 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 245999 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 03026400 | 05 | NY | MEDICAID |