Healthcare Provider Details

I. General information

NPI: 1891438701
Provider Name (Legal Business Name): ALEX GRACIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 E 174TH ST
BRONX NY
10460-5060
US

IV. Provider business mailing address

1276 FULTON AVE
BRONX NY
10456-3467
US

V. Phone/Fax

Practice location:
  • Phone: 718-992-7669
  • Fax:
Mailing address:
  • Phone: 718-992-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number338775
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME175962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: