Healthcare Provider Details

I. General information

NPI: 1538096755
Provider Name (Legal Business Name): ALEC JOSEPH SIGNORILE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 TARGEE ST
STATEN ISLAND NY
10304-4300
US

IV. Provider business mailing address

1145 TARGEE STREET
STATEN ISLAND NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-3484
  • Fax:
Mailing address:
  • Phone: 718-351-3149
  • Fax: 718-351-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: