Healthcare Provider Details

I. General information

NPI: 1497676654
Provider Name (Legal Business Name): ALPACA MEDICAL SERVICES EAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 GRAND ST STE 6N
NEW YORK NY
10013-3953
US

IV. Provider business mailing address

1111B S GOVERNORS AVE STE 25569
DOVER DE
19904-6903
US

V. Phone/Fax

Practice location:
  • Phone: 917-341-1803
  • Fax: 302-274-0656
Mailing address:
  • Phone: 917-341-1803
  • Fax: 302-274-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GAO
Title or Position: OWNER
Credential:
Phone: 214-517-7619