Provider Demographics
NPI:1619966264
Name:KORTZ, ALISON MICHELLE (RPA C)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MICHELLE
Last Name:KORTZ
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:POSKANZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1547 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9543
Mailing Address - Country:US
Mailing Address - Phone:518-479-4156
Mailing Address - Fax:518-479-3794
Practice Address - Street 1:461 CLINTON ST EXT STE 1
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2425
Practice Address - Country:US
Practice Address - Phone:518-374-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0068271207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0906Medicare ID - Type Unspecified
S81902Medicare UPIN