Healthcare Provider Details

I. General information

NPI: 1316472194
Provider Name (Legal Business Name): ALDO ALLEVA, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SKILLMAN AVE
BROOKLYN NY
11211-2204
US

IV. Provider business mailing address

298 AINSLIE ST
BROOKLYN NY
11211-3816
US

V. Phone/Fax

Practice location:
  • Phone: 516-807-1608
  • Fax:
Mailing address:
  • Phone: 516-807-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2854131
License Number StateNY

VIII. Authorized Official

Name: ALDO ALLEVA
Title or Position: MD
Credential: MD
Phone: 516-807-1608