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General NPI Number Information
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NPI Number | 1730130386
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Entity Type | Individual
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Provider Name | MAURICE ALISSE PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 254 ROUTE 17K
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City | NEWBURGH
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State | NY
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Zip | 12550-8343
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Country | US
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Telephone | 845-565-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 243 NORTH RD STE 304
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-1173
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003971
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003971
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License Number State | NY
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