Provider Demographics
NPI:1205393824
Name:GOLDBERG, ALISSA JO (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JO
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:JO
Other - Last Name:STUBINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 HARRISON AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 HARRISON AVE STE 207
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1817
Practice Address - Country:US
Practice Address - Phone:617-636-0405
Practice Address - Fax:617-636-0408
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant