Healthcare Provider Details

I. General information

NPI: 1093232316
Provider Name (Legal Business Name): ALFONSINA RIOS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 ROUTE 9W STE 204
NEW WINDSOR NY
12553-6764
US

IV. Provider business mailing address

2187 HOLLAND AVE APT 2F
BRONX NY
10462-1765
US

V. Phone/Fax

Practice location:
  • Phone: 347-612-2014
  • Fax:
Mailing address:
  • Phone: 347-612-2014
  • Fax: 347-612-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406631-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number685391-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: