Healthcare Provider Details

I. General information

NPI: 1083394167
Provider Name (Legal Business Name): ALEXA DENA BRUCE PA - C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

PO BOX 29234
NEW YORK NY
10087-9234
US

V. Phone/Fax

Practice location:
  • Phone: 212-224-7988
  • Fax: 917-260-4828
Mailing address:
  • Phone: 212-224-7988
  • Fax: 917-260-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number35110
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: