Provider Demographics
NPI:1518047430
Name:NEUBERT, CARISSA A (PAC)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:A
Last Name:NEUBERT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:A
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3909
Mailing Address - Fax:
Practice Address - Street 1:95 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1601
Practice Address - Country:US
Practice Address - Phone:607-563-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011821-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant