Healthcare Provider Details

I. General information

NPI: 1649878729
Provider Name (Legal Business Name): ASHLEY ALISSA KLEINERMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY ALISSA GOFF

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SOUTH ST
GLENS FALLS NY
12801-4328
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-7841
  • Fax: 518-932-0289
Mailing address:
  • Phone: 518-761-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: