Provider Demographics
NPI:1063484087
Name:ALEA, MYRIAN MERCEDES (MD)
Entity type:Individual
Prefix:DR
First Name:MYRIAN
Middle Name:MERCEDES
Last Name:ALEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRIAN
Other - Middle Name:
Other - Last Name:ALEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2402
Mailing Address - Country:US
Mailing Address - Phone:718-920-5312
Mailing Address - Fax:718-798-6485
Practice Address - Street 1:110 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5312
Practice Address - Fax:718-798-6485
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2991392080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26277OtherBCBS
FL376549100Medicaid
FL26277OtherBCBS
FL26277W & 26277VMedicare PIN