Provider Demographics
NPI:1164882064
Name:GILBERT, ALIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ALIE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 ELLICOTT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1245
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:716-893-1002
Practice Address - Street 1:40 LA RIVIERE DR STE 201
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4344
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:716-893-1002
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant