Active NPI
Alexandre B Blaivas, M.D.
- Psychiatry Physician
- Staten Island, NY
National Provider Identifier
1063696326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 234568
- Practice address
- 75 Vanderbilt Ave
Fifth Floor
Staten Island, NY 10304-2604 - Phone
- (718) 818-6131
- NPI assigned
- Dec 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 234568 | MA | Primary |
Addresses
Primary practice location
75 Vanderbilt Ave
Fifth Floor
Staten Island, NY 10304-2604
Mailing address
355 Bard Ave
Staten Island, NY 10310-1664
Phone (718) 818-6131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 234568 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279843200000",
"number": "1063696326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "355 BARD AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103101664",
"telephone_number": "718-818-6131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 VANDERBILT AVE",
"address_2": "FIFTH FLOOR",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103042604",
"telephone_number": "718-818-6131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAIVAS",
"first_name": "ALEXANDRE",
"middle_name": "B",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-21",
"last_updated": "2010-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "234568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.