Healthcare Provider Details

I. General information

NPI: 1114676426
Provider Name (Legal Business Name): JESSICA SOLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 PARK AVE S FL 9
NEW YORK NY
10016-7570
US

IV. Provider business mailing address

461 PARK AVE S FL 9
NEW YORK NY
10016-7570
US

V. Phone/Fax

Practice location:
  • Phone: 212-545-1888
  • Fax: 212-545-1919
Mailing address:
  • Phone: 212-545-1888
  • Fax: 212-545-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number327584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: