Healthcare Provider Details

I. General information

NPI: 1245180272
Provider Name (Legal Business Name): ALEX ANTONIO ESTRADA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OHIO DR STE 200
NEW HYDE PARK NY
11042-1144
US

IV. Provider business mailing address

39 BIRCHWOOD DR N
VALLEY STREAM NY
11580-1905
US

V. Phone/Fax

Practice location:
  • Phone: 516-207-7200
  • Fax:
Mailing address:
  • Phone: 516-316-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: