Healthcare Provider Details

I. General information

NPI: 1710609755
Provider Name (Legal Business Name): ALYSSA LAXER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 WILLIAM ST FL 5
NEW YORK NY
10038-2602
US

IV. Provider business mailing address

163 WILLIAM ST FL 5
NEW YORK NY
10038-2602
US

V. Phone/Fax

Practice location:
  • Phone: 212-618-6052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: