Healthcare Provider Details

I. General information

NPI: 1073446795
Provider Name (Legal Business Name): ALYSSA IRYAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

32 S OAKS BLVD
PLAINVIEW NY
11803-1935
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5098
  • Fax: 212-305-2168
Mailing address:
  • Phone: 516-697-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036007
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: