1497676654 NPI number — ALPACA MEDICAL SERVICES EAST PC

Table of content: MS. JILL NYDAM LPC (NPI 1821587809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497676654 NPI number — ALPACA MEDICAL SERVICES EAST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPACA MEDICAL SERVICES EAST PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497676654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111B S GOVERNORS AVE STE 25569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19904-6903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-341-1803
Provider Business Mailing Address Fax Number:
302-274-0656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
197 GRAND ST STE 6N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-341-1803
Provider Business Practice Location Address Fax Number:
302-274-0656
Provider Enumeration Date:
07/23/2026

Additional Information

Authorized Official

Authorized Official Last Name:
GAO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-517-7619

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com