Dr. Alexis Nicheporuck, MD
Radiology, Diagnostic Radiology in Staten Island, NY. Individual provider (NPI-1).
NPI number1336760784
StatusActive
Last updated in NPPESSep 8, 2025
Details
- NPI
- 1336760784
- Entity type
- Individual (NPI-1)
- Name
- Dr. Alexis Nicheporuck
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 27, 2020
- Certification date
- Sep 8, 2025
- Last updated
- Sep 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | MD491302 | PA | Yes |
Practice location
475 Seaview AveStaten Island, NY 10305-3436
Phone 718-226-8313
Mailing address
66 Randolph PlWest Orange, NJ 07052-4853
Phone 973-900-1280
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