Healthcare Provider Details

I. General information

NPI: 1740147594
Provider Name (Legal Business Name): JESSICA ALCAIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933B MORRIS PARK AVE
BRONX NY
10462-3711
US

IV. Provider business mailing address

3058 74TH ST FL 1
EAST ELMHURST NY
11370-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-379-2229
  • Fax:
Mailing address:
  • Phone: 646-934-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1627852221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: