Provider Demographics
NPI:1740386168
Name:ALECCIA, DORENE A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DORENE
Middle Name:A
Last Name:ALECCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276-280 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1659
Mailing Address - Country:US
Mailing Address - Phone:607-771-7234
Mailing Address - Fax:607-772-2095
Practice Address - Street 1:276-280 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1659
Practice Address - Country:US
Practice Address - Phone:607-771-7234
Practice Address - Fax:607-772-2095
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB9583Medicare ID - Type Unspecified
NYP01142Medicare UPIN