1205536679 NPI number — ALYSSA LOUISE NIEVES PACIA

Table of content: ALYSSA LOUISE NIEVES PACIA (NPI 1205536679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205536679 NPI number — ALYSSA LOUISE NIEVES PACIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACIA
Provider First Name:
ALYSSA LOUISE
Provider Middle Name:
NIEVES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1205536679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7322 53RD RD APT 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASPETH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11378-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-656-9078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10825 63RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-896-2011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  05002601 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 775585516 . This is a "LEARNER PERMIT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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