Alexander Ivanov, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

205206 Issued in NY

Practice address

115 Brightwater CT
Brooklyn, NY 11235-7652

Phone

(718) 975-7690

Fax

(718) 975-7690

NPI assigned

Feb 7, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• NJ Wellness Center PC

  • Psychologist
  • Cliffside Park, NJ
  • NPI 1558752410
  NPD
• Ohel Children's Home and Family Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hollywood, FL
  • NPI 1629851613
  NPD (past)
• Trinitas Regional Medical Center

  dba Trinitas Cranford Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cranford, NJ
  • NPI 1518423698
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1790825222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 WATER ST",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088614703",
            "telephone_number": "718-975-7690",
            "fax_number": "718-975-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BRIGHTWATER CT",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357652",
            "telephone_number": "718-975-7690",
            "fax_number": "718-975-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOV",
        "first_name": "ALEXANDER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "205206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01842337",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• IV Licensed Clinical Social Work P.C.
• IV Medical New York, PLLC
• Natalya Ivanina
• Lesya Ivankiv, FNP
• Igor Ivankov
• Andrey Ivanov, DDS
• Olga Ivanov, RD
• Zlatin S Ivanov
• Anna Ivanova-Tatlici, LMHC
• Anastasia Ivanova, M.S. CCC-SLP, TSSLD

• Psychiatry Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.