Healthcare Provider Details

I. General information

NPI: 1760635825
Provider Name (Legal Business Name): LUCIA ALVA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 CENTRAL AVE
FAR ROCKAWAY NY
11691-4002
US

IV. Provider business mailing address

1624 CENTRAL AVE
FAR ROCKAWAY NY
11691-4002
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-8014
  • Fax: 516-888-1550
Mailing address:
  • Phone: 516-377-8014
  • Fax: 516-888-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: