Provider Information for 1275385726
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ALEXANDRIA LAKE
Sex: Female
NPI: 1275385726
Last Updated: 2024-04-05
Certification Date: 2024-04-05
Certification Date: 2024-04-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1275385726 | ||||||||
| Enumeration Date | 2024-04-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1045 JAMES ST STE 100 SYRACUSE, NY 13203-2758 United States Phone: 315-363-0048 | Fax:315-363-0052 | ||||||||
| Primary Practice Address | 1045 JAMES ST STE 100 SYRACUSE, NY 13203-2758 United States Phone: 315-363-0048 | Fax:315-363-0052 | ||||||||
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