Healthcare Provider Details

I. General information

NPI: 1073106019
Provider Name (Legal Business Name): ALICIA JASMINE FERDINAND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WHITE PLAINS RD
EASTCHESTER NY
10709-2826
US

IV. Provider business mailing address

130 LENOX AVE
NEW YORK NY
10026-2503
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 774-289-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF347287-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF347287-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: