Healthcare Provider Details

I. General information

NPI: 1295340685
Provider Name (Legal Business Name): DANA ALBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 QUEENS PLZ N
LONG ISLAND CITY NY
11101-4172
US

IV. Provider business mailing address

15338 77TH AVE
FLUSHING NY
11367-3128
US

V. Phone/Fax

Practice location:
  • Phone: 718-391-3800
  • Fax:
Mailing address:
  • Phone: 224-260-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number748903-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: