Healthcare Provider Details

I. General information

NPI: 1548473051
Provider Name (Legal Business Name): ALICE GRACE FERNANDEZ B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CANNON PL
BRONX NY
10463-4302
US

IV. Provider business mailing address

2400 HUDSON TERRACE #4D
FORT LEE NJ
07024
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-8100
  • Fax:
Mailing address:
  • Phone: 201-944-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number012416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: