Provider Demographics
NPI:1568580595
Name:POYSS, ALICEMARIE (APN,C)
Entity Type:Individual
Prefix:MS
First Name:ALICEMARIE
Middle Name:
Last Name:POYSS
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8525
Mailing Address - Country:US
Mailing Address - Phone:609-654-0946
Mailing Address - Fax:609-953-1825
Practice Address - Street 1:767 E ROUTE 70
Practice Address - Street 2:SUITE B-101
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2341
Practice Address - Country:US
Practice Address - Phone:856-983-9939
Practice Address - Fax:856-983-9936
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06596800363LA2100X
PASP004161M363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8882002Medicaid
NJ8882002Medicaid
NJ036845TLDMedicare ID - Type Unspecified