Healthcare Provider Details

I. General information

NPI: 1104808203
Provider Name (Legal Business Name): ALAN J WINNEY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

IV. Provider business mailing address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

V. Phone/Fax

Practice location:
  • Phone: 315-535-9202
  • Fax: 315-535-9207
Mailing address:
  • Phone: 315-535-9202
  • Fax: 315-535-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: