Healthcare Provider Details

I. General information

NPI: 1710823281
Provider Name (Legal Business Name): ALINA PENA ADAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 QUEENS BLVD STE 2701
KEW GARDENS NY
11415-1511
US

IV. Provider business mailing address

258 MADISON ST
MAMARONECK NY
10543-1817
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-0444
  • Fax:
Mailing address:
  • Phone: 929-276-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: